Sample records for prevention diagnosis treatment

  1. HIV / AIDS: Symptoms, Diagnosis, Prevention and Treatment (United States)

    Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / ... Most people who have become recently infected with HIV will not have any symptoms. They may, however, ...

  2. Deep vein thrombosis: diagnosis, treatment, and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, W.P.; Youngswick, F.D.

    Deep vein thrombosis (DVT) is a dangerous complication that may present after elective foot surgery. Because of the frequency with which DVT occurs in the elderly patient, as well as in the podiatric surgical population, the podiatrist should be acquainted with this entity. A review of the diagnosis, treatment, prevention, and the role of podiatry in the management of DVT is discussed in this paper.

  3. The prevention, diagnosis, and treatment of dyslexia. (United States)

    Schulte-Körne, Gerd


    Reading and spelling disorder (dyslexia) is one of the more common specific developmental disorders, with a prevalence of approximately 5%. It is characterized by severe impairment of learning to read and spell. We discuss major aspects of the diagnosis, treatment, and prevention of dyslexia on the basis of a selective literature review and the guidelines of the German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy. 40% to 60% of dyslexic children have psychological manifestations, including anxiety, depression, and attention deficit. The diagnostic assessment of dyslexia consists of a battery of standardized reading and spelling tests and an evaluation of the child's psychological state, including additional information obtained from parents and teachers. The treatment of dyslexia is based on two main strategies: specific assistance with the impaired learning areas (reading and spelling) and psychotherapy for any coexisting psychological disturbance that may be present. Evaluated preventive strategies are available for use in kindergarten and at home. The diagnosis of dyslexia should be established with the aid of the multiaxial classification system. The benefit of specific treatment strategies for dyslexia has not yet been demonstrated empirically. Nonetheless, evaluated prevention programs are available in kindergarten that have been found to promote children's ability to acquire reading and spelling skills in school.

  4. Milk Fistula: Diagnosis, Prevention, and Treatment. (United States)

    Larson, Kelsey E; Valente, Stephanie A


    Milk fistula is an uncommon condition which occurs when there is an abnormal connection that forms between the skin surface and the duct in the breast of a lactating woman, resulting in spontaneous and often constant drainage of milk from this path of least resistance. A milk fistula is usually a complication that results from a needle biopsy or surgical intervention in a lactating patient. Here, the authors present an unusual case of a spontaneous milk fistula which developed from an abscess in the breast of a lactating woman. The patient initially presented to the office with a large open wound on her breast, formed from skin breakdown, within which milk was pooling. She was treated with local wound care and cessation of breastfeeding, with appropriate healing of the wound and closure of the fistula with 6 weeks. Diagnosis, prevention, and treatment of milk fistula were reviewed. © 2015 Wiley Periodicals, Inc.

  5. The post-discectomy syndrome. Aetiology, diagnosis, treatment, prevention. (United States)

    Ivanic, G M; Pink, T P; Homann, N C; Scheitza, W; Goyal, S


    The post-discectomy syndrome (PDS) is a common diagnosis in patients with problems following a disc operation. The different causes of PDS make the establishment of the correct diagnosis and its corresponding efficient treatment difficult. A general overview published in the bibliographical data covering the entity of PDS is rare. The following paper aims to specify PDS according to its aetiology, diagnosis, treatment and prevention. The diagnosis should be made efficiently, so that the patient can receive prompt adequate therapy.

  6. Herpes Genitalis: Diagnosis, Treatment and Prevention (United States)

    Sauerbrei, A.


    Herpes genitalis is caused by the herpes simplex virus type 1 or type 2 and can manifest as primary or recurrent infection. It is one of the most common sexually transmitted infections and due to associated physical and psychological morbidity it constitutes a considerable, often underestimated medical problem. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laboratory diagnostics, antiviral therapy and prophylaxis. The article is aimed at all health-care workers managing patients with herpes genitalis and attempts to improve the often suboptimal counselling, targeted use of laboratory diagnostics, treatment and preventive measures provided to patients. PMID:28017972

  7. Current problems of prevention diagnosis and treatment of radiation sickness

    International Nuclear Information System (INIS)

    Gus'kova, A.K.


    Causes of increasing interest to the problems of prevention, diagnosis and treatment of radiation sickness are presented. On the basis of recent publications some new aspects as quantitative criteria in radiobiology, organization problems of medical aid at radiation incidents estimation of efficiency of preventive medicine and radiation sickness therapy, theoretical development of radiotherapy of different organs et al., are characterized

  8. Feature Hepatitis: Hepatitis Symptoms, Diagnosis, Treatment & Prevention (United States)

    ... many NIDDK research projects related to hepatitis and liver disease: A recent study concluded that about half of patients with chronic hepatitis C recovered after receiving initial treatments from two drugs, ...

  9. [Complications of cervicofacial radiotherapy. Prevention, diagnosis and multidisciplinary treatment]. (United States)

    Mano Azul, A; Rebelo, H


    This paper presents a review on the state of art about scientific knowledge on oral complications of head and neck radiotherapy, in an attempt to contribute for a better prevention, diagnosis and treatment. The authors also describe the protocols used on Instituto Português de Oncologia of Lisboa.

  10. [Psychological and behavioural symptoms of dementia: prevention, diagnosis and treatment]. (United States)

    Olazaran-Rodriguez, J; Aguera-Ortiz, L F; Muniz-Schwochert, R


    The psychological and behavioural symptoms of dementia (BPSD) [corrected] give rise to personal suffering, are the cause of added deterioration and worsen the economic and social cost of dementias. To offer a systematic approach to the prevention, diagnosis and treatment of BPSD. [corrected]. The study adopts a global perspective that takes into account biological, psychological and social factors in an attempt to avoid both excessive medicalisation and a purely psychology-based attitude. Satisfying basic needs, treating medical and psychiatric comorbidity, the adaptation of the setting, and the specific pharmacological treatment of dementia, as well as offering patients and their caregivers the counselling and support they need, all contribute to prevent the onset of BPSD. [corrected]. The diagnosis of BPSD [corrected] is based on the patient's medical history and on observation. It is useful to identify a primary or destabilising BPSD [corrected] on which to deploy hypotheses and specific treatments based on modifying the environment, drugs, non-pharmacological therapies and continuous assessment. Any action taken must be integrated within a person-focused care plan aimed at accomplishing the patients' and their caregivers' welfare and quality of life. BPSD [corrected] are the result of biological, psychological and social factors. In the present scenario, in which there are no curative treatments in most cases of dementia, a systematic and multidisciplinary approach aimed at preventing and treating BPSD [corrected] is a highly cost-effective therapeutic opportunity in both personal and social terms.

  11. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment. (United States)

    Martins, Natália; Ferreira, Isabel C F R; Barros, Lillian; Silva, Sónia; Henriques, Mariana


    Candidiasis is the most common opportunistic yeast infection. Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients, but also related to nosocomial infections and even in healthy individuals. There is a widely variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. Due to rapid increase in the incidence in these infections, this is the subject of numerous studies. Recently, the focus of attention is the treatment and, above all, the prevention of those complications. The diagnosis of candidiasis could become quite complicated. Prevention is the most effective "treatment," much more than eradication of the yeast with antifungal agents. There are several aspects to consider in the daily routine that can provide a strength protection. However, a therapeutic approach is necessary when the infection is established, and therefore, other alternatives should be explored. This review provides an overview on predisposition factors, prevention and diagnosis of candidiasis, highlighting alternative approaches for candidiasis treatment.

  12. Osteoradionecrosis of the mandible: Etiology, prevention, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Rayatt Sukh


    Full Text Available The treatment of head and neck cancer remains a challenge. Despite advances in surgical reconstructive techniques, most patients will require adjuvant therapy in the form of radiotherapy or chemo-radiotherapy to improve locoregional control. The short- and long term side effects of radiotherapy can be difficult to treat. In this review the causative effects and pathogenesis of osteoradionecrosis of the mandible will be highlighted. In addition, preventive measures and clinical features of radiotherapy induced damage will be presented. Finally, medical and surgical management of osteoradionecrosis, as well as, reconstructive surgery of the mandible will be discussed. At the end of this paper the reader should have up to date knowledge concerning the etiology, prevention, diagnosis and treatment of patients with osteoradionecrosis of the mandible.

  13. Neonatal Respiratory Distress Syndrome: Early Diagnosis, Prevention, and Treatment

    Directory of Open Access Journals (Sweden)

    S. A. Perepelitsa


    Full Text Available to improve treatment results in premature infants with neonatal respiratory distress syndrome (NRDS, by establishing developmental mechanisms and elaborating methods for its early diagnosis, treatment, and prevention. Material and methods. The paper analyzes the results of a clinical observation and laboratory, instrumental, immunological, morphological, and radiological studies of 320 premature neonates at 26—35 weeks gestational age. The following groups of neonates were identified: 1 40 premature neonatal infants without NRDS and with the physiological course of an early neonatal period (a comparison group; 2 190 premature neonates with severe NRDS in whom the efficiency of therapy with exogenous surfactants, such as surfactant BL versus curosurf, was evaluated; 3 90 premature newborn infants who had died from NRDS at its different stages. Results. The poor maternal somatic, obstetric, and gynecological histories in the early periods of the current pregnancy create prerequisites for its termination, favor the development of severe acute gestosis, and cause abnormal placental changes. Each gestational age is marked by certain placental changes that promote impaired uterineplacentalfetal blood flow and premature birth. Alveolar and bronchial epithelial damages, including those ante and intranatally, microcircula tory disorders play a leading role in the tanatogenesis of NRDS. Intranatal hypoxia and amniotic fluid aspiration are one of the important factors contributing to alveolar epithelial damage and NRDS in premature neonates. Exogenous surfactants prevent the development of hyaline membranes and are useful in the normalization of ventilation-perfusion relationships and lung biomechanical properties. Conclusion. This study could improve the diagnosis and treatment of NRDS, which assisted in reducing the duration of mechanical ventilation from 130±7.6 to 65±11.6 hours, the number of complications (the incidence of intragastric

  14. Canine angiostrongylosis: recent advances in diagnosis, prevention, and treatment

    Directory of Open Access Journals (Sweden)

    Di Cesare A


    Full Text Available Angela Di Cesare, Donato Traversa Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy Abstract: Angiostrongylus vasorum is a parasitic nematode affecting the heart and pulmonary arteries of wild (eg, foxes and domestic canids. The parasite has an indirect life cycle in which slugs and snails act as intermediate hosts. In the last few years the parasite has spread outside the traditional endemic foci, and there is a rise of documented cases of canine angiostrongylosis across Europe. Angiostrongylus vasorum causes cardiopulmonary disorders and coagulopathies, along with different nonspecific clinical signs. Fatal infections are frequently reported. Given the severity of the infection and the recent geographic spreading of the parasite, this article reviews and discusses the current knowledge of A. vasorum, with a special focus on recent insights on diagnosis, prevention, and treatment of dog angiostrongylosis. Keywords: Angiostrongylus vasorum, dog, epidemiology, diagnostic approaches, control, therapy

  15. Food Allergies: Symptoms, Diagnosis, Prevention and Treatment | NIH MedlinePlus the Magazine (United States)

    ... of this page please turn Javascript on. Feature: Food Allergies Food Allergies: Symptoms, Diagnosis, Prevention and Treatment Past Issues / Spring ... available treatments only ease the symptoms. Preventing a food allergy reaction There are no drugs or treatments available ...

  16. Corneal allograft rejection: Risk factors, diagnosis, prevention, and treatment

    Directory of Open Access Journals (Sweden)

    Dua Harminder


    Full Text Available Recent advances in corneal graft technology, including donor tissue retrieval, storage and surgical techniques, have greatly improved the clinical outcome of corneal grafts. Despite these advances, immune mediated corneal graft rejection remains the single most important cause of corneal graft failure. Several host factors have been identified as conferring a "high risk" status to the host. These include: more than two quadrant vascularisation, with associated lymphatics, which augment the afferent and efferent arc of the immune response; herpes simplex keratitis; uveitis; silicone oil keratopathy; previous failed (rejected grafts; "hot eyes"; young recipient age; and multiple surgical procedures at the time of grafting. Large grafts, by virtue of being closer to the host limbus, with its complement of vessels and antigen-presenting Langerhans cells, also are more susceptible to rejection. The diagnosis of graft rejection is entirely clinical and in its early stages the clinical signs could be subtle. Graft rejection is largely mediated by the major histocompatibility antigens, minor antigens and perhaps blood group ABO antigens and some cornea-specific antigens. Just as rejection is mediated by active immune mediated events, the lack of rejection (tolerance is also sustained by active immune regulatory mechanisms. The anterior chamber associated immune deviation (ACAID and probably, conjunctiva associated lymphoid tissue (CALT induced mucosal tolerance, besides others, play an important role. Although graft rejection can lead to graft failure, most rejections can be readily controlled if appropriate management is commenced at the proper time. Topical steroids are the mainstay of graft rejection management. In the high-risk situations however, systemic steroids, and other immunosuppressive drugs such as cyclosporin and tacrolimus (FK506 are of proven benefit, both for treatment and prevention of rejection.

  17. Plague Diagnosis and Treatment (United States)

    ... Healthcare Professionals Clinicians Public Health Officials Veterinarians Prevention History of Plague Resources FAQ Diagnosis and Treatment Recommend on Facebook Tweet Share Compartir Detailed Diagnosis and Treatment Recommendations ...

  18. Guidelines for the diagnosis, prevention and treatment of osteoporosis

    Directory of Open Access Journals (Sweden)

    M. Rossini


    Full Text Available The guidelines for the osteoporosis management were first drafted by a working group and then critically evaluated by the board of SIOMMMS. The most relevant points are: Definition: Osteoporosis is defined as a quantitative and qualitative deterioration of bone tissue leading to increased risk of fracture. Postmenopausal and senile osteoporosis are defined as primitive. Diagnosis: The cornerstone for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD by DXA (dual-energy X-ray absortiometry at the femoral neck with T-score values -2.5 is usually not justified. Pharmacological intervention: The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk. This is the case only when the risk of fracture is rather high. FRAX™ is recognized as a useful tool for easily estimate the long-term fracture risk. SIOMMMS with these guidelines is committed to validate and further develop this diagnostic tool.

  19. [Paraphilia, sexual preference disorders. Diagnosis, etiology, epidemiology, treatment and prevention]. (United States)

    Berner, Wolfgang; Briken, P


    Hostility towards relationships is one prominent characteristic symptom for disorders of sexual preference (ICD-10) and paraphilias (DSM-IV). Paraphilic symptoms sometimes progress to obsessive or addictive- like forms leading to a loss of self-control but can occur also as single incidents or as episodic events. Besides constitutional aspects, problems in the development of close relationships to primary caregivers (attachment) play an important role in the development of these disorders. Actual relationship- and self-confidence problems often trigger the severity of disturbance, especially in the episodic forms of paraphilia. For patients who are in conflict with the law, cognitive-behavioral therapeutic approaches with the aim to minimize self-deception regarding the effects of the paraphilic behavior have become more and more relevant. Regarding the medical treatment, anti-hormonal therapy plays an important role, but also treatment with serotonergic agents and naltrexone are used. Only little can be advised in terms of prevention; general psycho-hygiene (regarding the parent-child relationship) is recommended. Beside these general measures, institutions which offer special treatment for people in danger to become delinquents may be able to prevent serious harm for possible victims of abuse.

  20. Osteoporosis: Symptoms, Diagnosis, Treatment and Prevention | NIH MedlinePlus the Magazine (United States)

    ... of this page please turn Javascript on. Feature: Osteoporosis Osteoporosis: Symptoms, Diagnosis, Treatment and Prevention Past Issues / Winter 2011 Table of Contents Osteoporosis can strike at any age, although the risk ...

  1. Orthopedic Health: Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment (United States)

    ... version of this page please turn Javascript on. Prevention Regular exercise, a balanced diet, and a healthful weight can help you reduce your risk of developing osteoarthritis, especially in the hips and knees, or suffering sports injuries. Exercise helps bone density, improves muscle strength and ...

  2. Guidelines for diagnosis, prevention and treatment of hand eczema

    DEFF Research Database (Denmark)

    Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver


    ) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in “head-to-head” RCTs are needed.The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried...

  3. [Prevention, diagnosis and treatment of blood group immunization during pregnancy]. (United States)

    van Aken, W G; Christiaens, G C


    In the Netherlands last year two important policy changes were introduced to prevent haemolytic disease of the newborn: antenatal administration of anti RhD immunoglobulin and screening for antibodies against irregular erythrocyte antigens in all pregnant women. As the predictive value of such antibodies for the detection of hemolytic disease of the newborn is limited, it is uncertain if this measure is really cost-effective. Because blood transfusion is the most important probable cause of the immunization, and because of the clinical severity of anti-K antibodies, it is advised to give exclusively K negative blood to girls and women under the age of 45 years. In addition there is a need for a uniform protocol to deal with women who have been exposed to immunization.

  4. [Nutritional deficiencies in bariatric surgery patients: prevention, diagnosis and treatment]. (United States)

    Schweiger, Chaya; Keidar, Andrei


    The number of people suffering from surgery and obesity in the western world is constantly growing. In 1997 the World Health Organization (WHO) defined obesity as a plague and one of greatest public health hazards of our time. The National Institution of Health (NIH) declared that surgery is the only long-term solution for obesity. Today there are four different types of bariatric surgery. Each variation has different implications on the nutritional status of bariatric surgery patients. Bariatric surgery candidates are at risk of developing vitamin and mineral nutritional deficiencies in the post-operative stage, due to vomiting, decrease in food intake, food intolerance, diminution of gastric secretions and bypass of absorption area. It is easier and more efficient to treat nutritional deficiencies in the preoperative stage. Therefore, preoperative detection and correction are crucial. Blood tests before surgery to detect and treat nutritional deficiencies are crucial. In the postoperative period, blood tests should be conducted every 3 months in the first year after operation, every six months in the second year and annually thereafter. Multivitamin is recommended to prevent nutritional deficiencies in all bariatric surgery patients. Furthermore, iron, calcium, Vitamin D and B12 are additionally recommended for Roux-en-Y Gastric Bypass patients. Patients with Biliopancreatic diversion and Duodenal Switch should also take fat soluble vitamins.

  5. Epidemiological overview, advances in diagnosis, prevention, treatment and management of epithelial ovarian cancer in Mexico. (United States)

    Gallardo-Rincón, Dolores; Espinosa-Romero, Raquel; Muñoz, Wendy Rosemary; Mendoza-Martínez, Roberto; Villar-Álvarez, Susana Del; Oñate-Ocaña, Luis; Isla-Ortiz, David; Márquez-Manríquez, Juan Pablo; Apodaca-Cruz, Ángel; Meneses-García, Abelardo


    The epithelial ovarian cancer (EOC) has been underdiagnosed because it does not have a specific clinical presentation, and the signs and symptoms are similar to the irritable bowel syndrome and pelvic inflammatory disease. EOC is less common than breast and cervical cancer, but it is more lethal. On the whole, EOC has an early dissemination to peritoneal cavity, which delays a timely diagnosis and increases the rate of advanced diagnosed disease. The diagnosis usually surprises the women and the primary care physician. Therefore, it is necessary to count on prevention and early diagnosis programs. EOC has 80% response to surgical treatment, but nearly 70% of the patients may relapse in five years. The objectives of this document are presenting a summary of the EOC epidemiology and comment about advancements in prevention, diagnosis, and treatment of this cancer. That will raise awareness about the importance of this disease.

  6. Stomach cancer involving esophagus. Diagnosis, treatment and prevention by specific methods.


    Filippov, Yu. О.; Tyutyunnik, V. M.


    Stomach cancer is a leader in the structure of cancer pathology in Ukraine and in the world. This paper summarizes own results and literature data on diagnosis, treatment and prevention of stomach cancer. Authors analyzed the experience and specific features of long-term treatment and diagnostic approach to patients with stomach cancer involving esophagus. Conducting pre-and postoperative cytostatic herbal therapy and cryosurgical operations during surgical treatment in patients with spread o...

  7. Management of delayed hemolytic transfusion reaction in sickle cell disease: Prevention, diagnosis, treatment. (United States)

    Pirenne, F; Bartolucci, P; Habibi, A


    Transfusion remains a key treatment of sickle cell disease complications. However, delayed hemolytic transfusion reaction, the most serious complication of transfusion, may be life-threatening if hyperhemolysis develops. This syndrome is generally underdiagnosed because its biological and clinical features resemble those of vaso-occlusive crisis, and red blood cell antibodies are frequently absent. Further transfusions may aggravate the symptoms, leading to severe multiple organ failure and death. It is therefore essential to prevent, diagnose and treat this syndrome efficiently. Prevention is based principally on the attenuation of allo-immunization through the provision of extended-matched RBCs or the use of rituximab. However, such treatment may be insufficient. Early diagnosis might make it possible to implement specific treatments in some cases, thereby avoiding the need for secondary transfusion. Diagnosis is dependent on the knowledge of the medical staff. Finally, many treatments, including steroids, immunoglobulins, erythropoietin and eculizumab, have been used to improve outcome. Improvements in our knowledge of the specific features of DHTR in SCD should facilitate management of this syndrome. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Trichotillomania and trichophagia - diagnosis, treatment, prevention. The attempt to establish guidelines of treatment in Poland. (United States)

    Gawłowska-Sawosz, Marta; Wolski, Marek; Kamiński, Andrzej; Albrecht, Piotr; Wolańczyk, Tomasz


    Trichotillomania is a disorder characterised by inability to control over pulling own hair from various parts of a body resulting in noticeable hair loss. Due to its long-term, progressive course, untreated trichotillomania can lead to disturbances in the functioning of patients and complications which are dangerous to life and health. Due to the ambiguous nature of the symptoms, they often remain unrecognised by clinicians. Most patients are afraid of revealing symptoms and reluctantly seek for professional help. In our opinion, it is necessary to increase the awareness of the disorder of physicians of different specialties to improve the detection, treatment efficacy and to prevent dangerous complications of trichotillomania. This paper summarises the current state of knowledge on the epidemiology, aetiology, clinical presentation, and treatment of trichotillomania. It is also an attempt to create guidelines in all cases of suspected trichotillomania - adapted to Polish conditions. It also highlights the importance of a multidisciplinary treatment as a condition of effectiveness of the therapy and prevention of relapse.

  9. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. (United States)

    Leung, Alexander A; Daskalopoulou, Stella S; Dasgupta, Kaberi; McBrien, Kerry; Butalia, Sonia; Zarnke, Kelly B; Nerenberg, Kara; Harris, Kevin C; Nakhla, Meranda; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Prasad, G V Ramesh; Gryn, Steven E; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Penner, S Brian; Burgess, Ellen; Sivapalan, Praveena; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Kline, Gregory; Leiter, Lawrence A; Jones, Charlotte; Côté, Anne-Marie; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Tsuyuki, Ross T; Hiremath, Swapnil; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Grégoire, Jean C; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Lear, Scott A; Moullec, Gregory; Gupta, Milan; Magee, Laura A; Logan, Alexander G; Dionne, Janis; Fournier, Anne; Benoit, Geneviève; Feber, Janusz; Poirier, Luc; Padwal, Raj S; Rabi, Doreen M


    Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  10. The biology, prevention, diagnosis and treatment of dental caries: scientific advances in the United States. (United States)

    Zero, Domenick T; Fontana, Margherita; Martínez-Mier, E Angeles; Ferreira-Zandoná, Andréa; Ando, Masatoshi; González-Cabezas, Carlos; Bayne, Stephen


    Scientific advances in cariology in the past 150 years have led to the understanding that dental caries is a chronic, dietomicrobial, site-specific disease caused by a shift from protective factors favoring tooth remineralization to destructive factors leading to demineralization. Epidemiologic data indicate that caries has changed in the last century; it now is distributed unequally in the U.S. population. People who are minorities, homeless, migrants, children with disabilities and of lower socioeconomic status suffer from the highest prevalence and severity of dental caries. Scientific advances have led to improvements in the prevention, diagnosis and treatment of dental caries, but there is a need for new diagnostic tools and treatment methods. and Future management of dental caries requires early detection and risk assessment if the profession is to achieve timely and cost-effective prevention and treatment for those who need it most. Dental professionals look forward to the day when people of all ages and backgrounds view dental caries as a disease of the past.

  11. The Role of Environmental Design in Cancer Prevention, Diagnosis, Treatment, and Survivorship: A Systematic Literature Review. (United States)

    Gharaveis, Arsalan; Kazem-Zadeh, Mahshad


    The purpose of this literature review is to provide a better understanding of the impact that environmental design can have on the process of cancer prevention, diagnosis, treatment, and survivorship. Cancer is considered a chronic disease in the United States, and more than 1.6 million new cases are diagnosed annually. New strategies of cancer care propose patient-centered services to achieve the best outcome, and researchers have found that environmental design can be an important part of improving this care. Searches were conducted in the PubMed and Google Scholar databases as well as in specific healthcare design journals such as Health Environments Research & Design, Environmental Psychology, and Environment and Behavior. The criteria for articles included in the review were (a) English-language articles related to facility design, which addressed (b) the topics of built environment in relation to cancer diagnosis, treatment, and survivorship, and were (c) published in peer-reviewed journals between 2000 and 2017. Finally, 10 articles were selected, and the contents were analyzed. The selected articles demonstrate that environmental design is one of the critical factors for success throughout the whole continuum of cancer care from diagnosis to end-of-treatment. Some of the specific conclusions from the review are that "neighborhood-oriented" design strategies can be beneficial (by providing accessibility to all facilities along the patient's path), that access to nature for patients, staff, and visitors alike is associated with better outcomes, and that provisions for natural lighting and noise reduction are associated with cancer patients' well-being.

  12. Latent M. tuberculosis infection--pathogenesis, diagnosis, treatment and prevention strategies. (United States)

    Druszczyńska, Magdalena; Kowalewicz-Kulbat, Magdalena; Fol, Marek; Włodarczyk, Marcin; Rudnicka, Wiesława


    One third of the earths population is infected with Mycobacterium tuberculosis (Mtb), but only 5-10% of the infected individuals develop active tuberculosis (TB) over their lifetime. The remaining 90-95% stay healthy and are called latently infected individuals. They are the biggest reservoir of the tubercle bacilli and identifying the cases of latent TB is a part of the global plan of TB control. From the clinical point of view detection of latent TB infections (LTBI) in individuals with the highest active TB risk including cases of HIV infection, autoimmune inflammatory diseases or cancer, is a priority. This review summarizes the recent findings in the pathogenesis of latent TB, its diagnosis, treatment and prevention.

  13. [Guidelines for diagnosis, treatment and prevention of infections in cancer patients 2013]. (United States)


    Cancer patients pose an increased risk of infectious complications due to their underlying disease and its treatment. The present guidelines, developed by the Commission of Infections in the Immunocompromised Host of the Argentine Society of Infectious Diseases are an updated version of those published in 2008. For the elaboration of these guidelines, both the scientific evidence and the local experience were thoroughly evaluated. This Consensus includes an overview of the risk factors and the epidemiology of infections in both adult and pediatric cancer patients. It deals with the management of the febrile neutropenic patient, the risk categorization, the initial empirical therapy in the multiresistant era and its subsequent management. It includes a section dedicated to the antifungal empirical and directed therapy as well as the diagnosis and treatment of the most frequent fungal infections. Prevention strategies, both general and for high-risk patients, including those receiving biologic response modifiers, are herein shown. These guidelines should be applied in conjunction with a careful clinical evaluation and taking into account local epidemiological factors. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  14. Oral diagnosis and treatment planning: part 6. Preventive and treatment planning for periodontal disease. (United States)

    Corbet, E; Smales, R


    A high level of sustained personal plaque control is fundamental for successful treatment outcomes in patients with active periodontal disease and, hence, oral hygiene instructions are the cornerstone of periodontal treatment planning. Other risk factors for periodontal disease also should be identified and modified where possible. Many restorative dental treatments in particular require the establishment of healthy periodontal tissues for their clinical success. Failure by patients to control dental plaque because of inappropriate designs and materials for restorations and prostheses will result in the long-term failure of the restorations and the loss of supporting tissues. Periodontal treatment planning considerations are also very relevant to endodontic, orthodontic and osseointegrated dental implant conditions and proposed therapies.

  15. Impact of HLA-G analysis in prevention, diagnosis and treatment of pathological conditions (United States)

    Bortolotti, Daria; Gentili, Valentina; Rotola, Antonella; Cassai, Enzo; Rizzo, Roberta; Luca, Dario Di


    Human leukocyte antigen-G (HLA-G) is a non-classical HLA class I molecule that differs from classical HLA class I molecules by low polymorphism and tissue distribution. HLA-G is a tolerogenic molecule with an immune-modulatory and anti-inflammatory function on both innate and adaptative immunity. This peculiar characteristic of HLA-G has led to investigations of its role in pathological conditions in order to define possible uses in diagnosis, prevention and treatment. In recent years, HLA-G has been shown to have an important implication in different inflammatory and autoimmune diseases, pregnancy complications, tumor development and aggressiveness, and susceptibility to viral infections. In fact, HLA-G molecules have been reported to alternate at both genetic and protein level in different disease situations, supporting its crucial role in pathological conditions. Specific pathologies show altered levels of soluble (s)HLA-G and different HLA-G gene polymorphisms seem to correlate with disease. This review aims to update scientific knowledge on the contribution of HLA-G in managing pathological conditions. PMID:25237627


    Directory of Open Access Journals (Sweden)

    A. E. Khramov


    Full Text Available One of the most menacing complications of large joint total endoprosthesis (TE in patients with rheumatic diseases (RD is the development of periprosthetic infection (PI, progression of which may give rise not only to limb loss, but also death. At the same time, early diagnosis and adequate surgical care make it possible not only to arrest the infectious process, but also to preserve an implanted joint.Objective: to define criteria for the diagnosis, prevention, and treatment of PI after hip and knee joint (HJ and KJ TE in patients with RD.Subjects and methods. In 2009 to 2013, 654 KJ and 549 HJ TE was performed in the V.A. Nasonova Research Instituteof Rheumatology performed KJ (n = 654 and HJ (n = 549 joint ERs.Results and discussion. PI developed in 12 (3.63% and 8 (2.95% patients after KJ and HJ ER, respectively. Early, delayed, and late PI was seen in 11, 6, and 3 patients, respectively. Eleven patients with early PI underwent joint revision/ debridement with preservation of an endoprosthesis and replacement of HJ endoprosthetic inserts and heads. The operations were completed with the collagen hemobiotics being left in the wound and its drainage. Systemic antibiotic therapy was used for 4–6 weeks. No recurrent infection was observed in 9 cases. Two patients underwentresurgery, by setting suction-irrigation systems. Nine patients with delayed or late PI had the following operations: A single-stage revision operation (the endoprosthesis was removed and a new one was implanted was performed in two cases of stable endoprosthetic components and accurately verified low-virulent microorganisms susceptible to certain antibiotics. It was imperative to use cement with an antibiotic, collagen hemobiotics, and systemic antibiotic therapy for 6 weeks. The other 7 patients with unstable endoprosthetic components underwent two-stage revision: Stage 1, endoprosthetic removal and antibiotic-loaded spacer implantation; 6-12 weeks after

  17. National Guidelines «Acute Kidney Injury: Basic Principles of the Diagnosis, Prevention and Treatment (2015» Part I

    Directory of Open Access Journals (Sweden)

    A.V. Smirnov


    Full Text Available The main problems of acute kidney injury (AKI are considered. The necessity of introduction of the AKI concept into the practice of national health care is justified. Specific recommendations for the diagnosis, monitoring, prevention and treatment of this dangerous condition are given.

  18. Diagnosis, prevention and treatment of urinary tract infections in older people. (United States)

    Bardsley, Alison


    Urinary tract infections (UTIs) are common in older people, with the prevalence increasing with age in both sexes. UTI is a frequent reason for emergency admission to hospital. There are many conditions that contribute to older people being more at risk of UTI and the main preventive strategy is to avoid the use of indwelling urethral catheters. Where an indwelling catheter is inserted its continued use should be regularly reviewed and the catheter removed, especially if the reason for insertion is incontinence and the person becomes additionally incontinent of faeces. Diagnosis of UTI can be complex because older people do not always exhibit the signs and symptoms commonly associated with UTI. Diagnosis can be further complicated by a person's inability to provide a comprehensive history and by difficulties obtaining an uncontaminated, 'clean catch' urine specimen. Antibiotic therapy should not be used routinely for people with asymptomatic bacteriuria and, where antibiotics are required, healthcare professionals should follow local prescribing guidelines.

  19. Modern aspects of diagnosis, treatment and prevention of obesity in children

    Directory of Open Access Journals (Sweden)

    S.D. Saltanova


    Full Text Available Obesity is a topical medical and social problem. Prevalence of obesity is increasing among children. The number of children under 5 years of age with overweight and obesity in the world is 44 millions. Obesity in childhood is a risk factor for the development of severe concomitant pathologies. Childhood obesity is an important prognostic factor for obesity in adults. Measures to prevent and treat childhood obesity should be directed not only to the child, but also to the whole family. To prevent obesity, excessive calorie intake should be limited. To increase the effectiveness of preventing obesity among children, we should combine reduction of energy intake with an increased physical activity. Lifestyle modification (correction of nutrition, exercise and behavioral therapy is the main method of treating children’s obesity. Introduction of school programs that increase physical activity and optimize the nutrition improve the effectiveness of treatment for childhood obesity. In case of ineffectiveness of lifestyle modification, pharmacotherapy may be prescribed. Orlistat is a medication for the treatment of obesity in children. The effectiveness of pharmacotherapy is enhanced when it is combined with integrated programs of lifestyle modification. Bariatric surgery should be used in cases of morbid obesity or failure of non-surgical treatment. Surgical treatment leads to body mass index decrease, improvement of concomitant diseases and quality of life. Bariatric surgery also has a risk of side effects, which requires continuous monitoring of complications. For the treatment and prevention of obesity, children need a multidisciplinary approach involving different specialists.

  20. Recommendations for the diagnosis, treatment and prevention of the pneumonia acquired in the community in adults

    International Nuclear Information System (INIS)


    The pneumonia acquired in the community in adults, is the acute infection of the pulmonary parenchyma that is developed away from the hospital environment, it is manifested in the first 48 hours from the entrance to the hospital or after seven days of having left. The supplement includes clinical square, epidemiology, etiology classification, diagnostic, treatment and prevention among others

  1. Diagnosis, treatment and prevention of ankle sprains : an evidence-based clinical guideline

    NARCIS (Netherlands)

    Kerkhoffs, Gino M.; van den Bekerom, Michel; Elders, Leon A. M.; van Beek, Peter A.; Hullegie, Wim A. M.; Bloemers, Guus M. F. M.; de Heus, Elly M.; Loogman, Masja C. M.; Rosenbrand, Kitty C. J. G. M.; Kuipers, Ton; Hoogstraten, J. W. A. P.; Dekker, Rienk; ten Duis, Henk-Jan; van Dijk, C. Niek; van Tulder, Maurits W.; van der Wees, Philip J.; de Bie, Rob A.

    Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical


    Adeninskaya, E E; Bukhtiarov, I V; Bushmanov, A Iu; Dayhes, N A; Denisov, E I; Izmerov, N F; Mazitova, N N; Pankova, V B; Preobrazhenskaya, E A; Prokopenko, L V; Simonova, N I; Tavartkiladze, G A; Fedina, I N


    Noise induced hearing loss is a slowly developing hearing impairment, caused by occupational exposure to excessive noise levels, constitutes a lesion of the auditory analyzer and clinically manifested as chronic bilateral sensorineural hearing loss. Currently, there is not a treatment that provide a cure of sensorineural hearing loss. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and specific clinical symptoms of hearing loss, as well as the prevention of complications. We recommend using non-drug therapies that can improve blood flow in labyrinth, tissue and cellular metabolism.

  3. [Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery]. (United States)

    Wu, Haifu; Zhong, Ming; Zhou, Di; Shi, Chenye; Jiao, Heng; Wu, Wei; Chang, Xinxia; Cang, Jing; Bian, Hua


    Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical

  4. Ascaris lumbricoides: challenges in diagnosis, treatment and prevention strategies in a European refugee camp. (United States)

    Claus, Paul-Emile; Ceuppens, Anne-Sophie; Cool, Mike; Alliet, Gudrun


     The roundworm Ascaris lumbricoides is one of the most prevalent parasites belonging to the class of the soil-transmitted helminths. Infections are most common in developing countries with a tropical climate where sanitation and hygiene are poor. However, prevalence of ascariasis in industrialized countries is increasing because of immigration and increasing number of refugees.  We report a case of ascariasis in a female patient who was admitted to our hospital after she had left the informal refugee camp of Calais in the north of France.  After colonoscopic removal of the worm and treatment with mebendazole during three days the patient's symptoms had completely resolved. Medical treatment with benzimidazole derivatives is easy and inexpensive. To prevent parasitic infections in larger populations, mass drug administration should be repeated periodically and must be implemented along with additional measures such as improvements to water, sanitation and hygiene (WASH). These WASH programs have been proven to be highly effective, but access and follow-up are expensive and very difficult to organize in refugee camps, even in wealthy, industrialized countries. Despite being an old, well-known parasitic disease, ascariasis might reappear in certain populations at risk in industrialized countries. Detection, treatment and follow-up of these patients, and the organization of preventive measures remain challenging.

  5. Venous thromboses and thromboembolism in acute stroke: risk factors, diagnosis, treatment, and prevention

    Directory of Open Access Journals (Sweden)

    Andrei Viktorovich Fonyakin


    Full Text Available Stroke patients among all patients with somatic diseases are at one of the highest risks for venous thromboembolism (VTE. The proven risk factors for venous thrombosis in stroke are prolonged immobilization, elderly age, obesity, diabetes mellitus, and inherited coagulopathies. If no drug prevention is done, the course of stroke is complicated by deep vein thrombosis (DVT in 75% of the immobilized patients and pulmonary thromboembolism develops in 20%. At present there are mechanical, pharmacological, and combined DVT prevention strategies that may considerably lower the rate of pulmonary embolism. In stroke patients, the use of low-molecular-weight heparins (LMWH reduces therisk of DVT, without increasing the risk of hemorrhagic complications. Novel oral anticoagulants used to treat venous thrombosis and VTE in stroke patients are an equivalent alternative to LMWH therapy. Treatment with novel oral anticoagulants to prevent recurrent VTE is effective and safe and may be continued up to 1–2 years.

  6. [Prevention and Treatment of Common Acute Adverse Effects With Antipsychotic Use in Adults With Schizophrenia Diagnosis]. (United States)

    Arenas Borrero, Álvaro Enrique; Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Vélez Traslaviña, Ángela; Castro Díaz, Sergio Mario; Jaramillo González, Luis Eduardo; García Valencia, Jenny


    To determine the most adequate strategies for the prevention and treatment of the acute adverse effects of the use of antipsychotics. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. A systematic literature search was carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. The non-pharmacological interventions such as nutritional counseling by a nutritionist, exercise and psychotherapy are effective in preventing weight gain with the use of antipsychotics. (Kg Weight reduction in DM of -3.05 (-4.16, -1.94)). The antipsychotic change from olanzapine to aripiprazole showed weight loss and decreased BMI (decreased weight in KG DM -3.21 (-9.03, -2.61). The use of beta blockers was ineffective in reducing akathisia induced by antipsychotic; using as outcome the 50% reduction of symptoms of akathisia comparing beta-blockers with placebo RR was 1.4 (0.59, 1.83). It is recommended to make psychotherapeutic accompaniment and nutrition management of overweight for patients with weight gain. If these alternatives are ineffective is suggested to change the antipsychotic or consider starting metformin. For the management of drug-induced akathisia it is recommended to decrease the dose of the drug and the addition of lorazepam. It is recommended using 5mg biperiden IM or trihexyphenidyl 5mg orally in case of secondary acute dystonia and for the treatment of antipsychotic-induced parkinsonism to decrease the dose of antipsychotic or consider using 2 - 4mg/day of biperiden or diphenhydramine 50mg once daily. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  7. Congenital Cytomegalovirus infection: advances and challenges in diagnosis, prevention and treatment. (United States)

    Marsico, Concetta; Kimberlin, David W


    Cytomegalovirus (CMV) is the most frequent cause of congenital infection worldwide, with an estimated incidence in developing countries of 0.6-0.7% of all live births. The burden of disease related to congenital CMV in substantial, as it is the leading non-genetic cause of sensorineural hearing loss and an important cause of neurodevelopmental disabilities in children. Despite its clinical significance, congenital CMV infection often goes undetected because the majority of infected infants are asymptomatic at birth and screening programs have not been substantially implemented. Other than behavioral measures, effective interventions aimed at the prevention of maternal infection and of mother-to-child transmission are lacking. Due to a convergence of recent advances in both diagnostic and therapeutic strategies in infants with congenital CMV, though, the field likely will be changing rapidly over just the next few years. Specifically, a highly-sensitive screening test with high throughput potential has been developed, and treatment of infants symptomatically infected with congenital CMV has proven to be well-tolerated and effective in improving long-term hearing and neurodevelopmental outcomes.This review highlights the clinical importance of congenital CMV infection, the developments in laboratory diagnostics, and the benefits of antiviral therapy. It also identifies the global efforts still required in the prevention of maternal infection and in the optimization of antiviral therapy to further reduce the burden of congenital CMV disease.


    Merzlova, N B; Serova, I A; Yagodina, A Yu


    A retrospective survey of the prevalence of TORCH infections among pregnant women was performed in the perinatal center, M. A. Tverye Military Sanitary Unit Nine (Perm), in June 2010 to December 2013. The survey covered 2060 women: they were all examined for cytomegalovirus, herpes simplex virus, and Toxoplasma. Antibodies to Toxoplasma gondii were detected in 28.68% (591/2060); 98.62% were found to have antibodies to herpes simplex; antibodies to cytomegalovirus were identified in 87.13% (1795/2060). Acute maternal toxoplasmosis was diagnosed by seroconversion or determination of IgM anti-Toxoplasma gondii antibodies, in the presence of a low avidity index and a four-fold increase in antibody titers, by simultaneously studying paired serum samples obtained at a 2-week interval. To confirm fetal infection, amniotic fluid PCR examination should be performed after 18 weeks' gestation. No consensus of opinion as to the principles of treatment for toxoplasmosis in pregnant women makes relevant the long-term results of antibacterial and antiprotozoal treatment cycles varying in duration and intensity. The prevention of acute toxoplasmosis in pregnant women ensures the principle of a mother's personal responsibility for infection safety of a newborn infant, which is informationally provided in health and safety fundamentals course and pregravid preparation schools.

  9. Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services. (United States)

    Getahun, Haileyesus; Sculier, Delphine; Sismanidis, Charalambos; Grzemska, Malgorzata; Raviglione, Mario


    Tuberculosis affected an estimated 8.8 million people and caused 1.4 million deaths globally in 2010, including a half-million women and at least 64 000 children. It also results in nearly 10 million cumulative orphans due to parental deaths. Moreover, it causes 6%-15% of all maternal mortality, which increases to 15%-34% if only indirect causes are considered. Increasingly, more women with tuberculosis are notified than men in settings with a high prevalence of human immunodeficiency virus (HIV), and maternal tuberculosis increases the vertical transmission of HIV. Tuberculosis prevention, diagnosis, and treatment services should be included as key interventions in the integrated management of pregnancy and child health. Tuberculosis screening using a simple clinical algorithm that relies on the absence of current cough, fever, weight loss, and night sweats should be used to identify eligible pregnant women living with HIV for isoniazid preventive therapy or for further investigation for tuberculosis disease as part of services for prevention of vertical HIV transmission. While implementing these simple, low-cost, effective interventions as part of maternal, neonatal, and child health services, the unmet basic and operational tuberculosis research needs of children, pregnant, and breastfeeding women should be addressed. National policy makers, program managers, and international stakeholders (eg, United Nations bodies, donors, and implementers) working on maternal, neonatal, and child health, especially in HIV-prevalent settings, should give due attention and include tuberculosis prevention, diagnosis, and treatment services as part of their core functions and address the public health impacts of tuberculosis in their programs and services.

  10. Diagnosis prevention and treatment for PICC-related upper extremity deep vein thrombosis in breast cancer patients. (United States)

    Xing, Lei; Adhikari, Vishnu Prasad; Liu, Hong; Kong, Ling Quan; Liu, Sheng Chun; Li, Hong Yuan; Ren, Guo Sheng; Luo, Feng; Wu, Kai Nan


    To study the incidence, diagnosis, prevention and treatment of peripherally inserted central catheter (PICC)-related upper extremity deep vein thrombosis (DVT) in breast cancer patients using a PICC catheter for chemotherapy. The data of the incidence, diagnosis and treatment of PICC-related upper extremity DVT in 187 breast cancer patients using a PICC catheter for chemotherapy, from August 2009 to July 2011 were retrospectively analyzed. In total 188 PICC were inserted between August 2009 and July 2011 and followed up for a total of 14 399 catheter-days (median placement, 76.6 days; range, 1 to 170 days). Four (2.1%) of 188 PICC were removed as a result of PICC-related upper extremity DVT in 14 to 112 catheter-days, at a rate of 0.28/1000 catheter-days. The use of PICCs in breast cancer patients for chemotherapy is safe and effective. However, some patients may develop catheter-related upper extremity DVT. In order to minimize complications, we should pay attention to its early symptoms and signs, as well as the timely removal of the catheter and appropriate anti-coagulant treatment. © 2012 Wiley Publishing Asia Pty Ltd.

  11. Vaginitis: Diagnosis and Treatment. (United States)

    Paladine, Heather L; Desai, Urmi A


    Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Bacterial vaginosis is implicated in 40% to 50% of cases when a cause is identified, with vulvovaginal candidiasis accounting for 20% to 25% and trichomoniasis for 15% to 20% of cases. Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5% to 10% of vaginitis cases. Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing. Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard. Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain. Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin. The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available. Culture can be helpful for the diagnosis of complicated vulvovaginal candidiasis by identifying nonalbicans strains of Candida. Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy. The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women. Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well. Treatment of noninfectious vaginitis should be directed at the underlying cause. Atrophic vaginitis is treated with hormonal and nonhormonal therapies. Inflammatory vaginitis may improve with

  12. Beals syndrome (congenital contractural arachnodactyly in children: Clinical symptoms, diagnosis, treatment, and prevention

    Directory of Open Access Journals (Sweden)

    A. N. Semyachkina


    Full Text Available The paper deals with a rare monogenic connective tissue disease from a group of fibrillinopathies with autosomal dominant inheritance — Beals syndrome caused by a mutation in the FBN2 gene. Attention is drawn to the high phenotypic similarity of this disease and Marfan syndrome (FBN1 gene mutation, which is associated with the almost complete identity of two proteins: fibrillin 1 and fibrillin 2.The paper describes a clinical case of a child with Beals syndrome and the typical manifestations of the disease: asthenic constitution, arachnodactyly of the hands and feet, congenital contractures of the large and small joints, chest deformity, kyphoscoliosis, talpes, and crushed ears. The investigators made a differential diagnosis with other connective tissue diseases, such as Marfan syndrome, Stickler syndrome, Ehlers–Danlos syndrome, homocystenuria, and arthrogryposis. DNA diagnosis verified the Beals syndrome in the proband. Exon 28 in the FBN2 gene showed the previously undescribed missense mutation of c.3719G>A, resulting in the amino acid substitution of cysteine for tyrosine (p.Cys1240Tyr in the structure of the protein fibrillin 2. A de novo mutation occurred. There is evidence for its pathogenicity in the development of the clinical symptoms of the disease. The problems of effective medical genetic counseling in this family are discussed. 

  13. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. (United States)

    Holick, Michael F


    Vitamin D deficiency and insufficiency is a global health issue that afflicts more than one billion children and adults worldwide. The consequences of vitamin D deficiency cannot be under estimated. There has been an association of vitamin D deficiency with a myriad of acute and chronic illnesses including preeclampsia, childhood dental caries, periodontitis, autoimmune disorders, infectious diseases, cardiovascular disease, deadly cancers, type 2 diabetes and neurological disorders. This review is to put into perspective the controversy surrounding the definition for vitamin D deficiency and insufficiency as well as providing guidance for how to treat and prevent vitamin D deficiency.

  14. Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. (United States)

    Ricci-Cabello, I; Ruiz-Pérez, I; Olry de Labry-Lima, A; Márquez-Calderón, S


    The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results. © 2010 Blackwell Publishing Ltd.

  15. Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention. (United States)

    Gabbe, Steven G; Melville, Jennifer; Mandel, Lynn; Walker, Edward


    The purpose of this study was to determine the prevalence of burnout in chairs of academic departments of obstetrics and gynecology, identify important stressors, and develop strategies to treat and prevent burnout. We performed a cross-sectional study of 131 chairs in the United States and Puerto Rico. We used a 6-part questionnaire focusing on demographics, potential stressors, satisfaction with personal and professional life, self-efficacy, burnout as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and support from the spouse/partner and family. Statistical analyses were performed with the chi(2) test for categorical variables and t test or analysis of variance for continuous variables. Questionnaires were returned from 119 chairs, 110 men and 9 women, a response rate of 91%. Chairs had served an average of 7.2 years. They worked an average of 67.4 hours each week, spending 45% of their time in administrative duties, 31% in patient care, 15% in teaching, and 8% in research. Female chairs worked significantly more hours per week than male chairs, 76.9 versus 66.7 hours (P =.005). Chairs who had served >10 years worked significantly fewer hours each week than did those who had been chairs budget deficits, Medicare/Medicaid billing audits, loss of key faculty, union disputes, and faculty, resident, and staff dismissals. To deal with stress, chairs most often spent time with family and friends. Twenty-two percent of chairs were somewhat-very dissatisfied with their positions. The MBI-HSS revealed a high subscale score for emotional exhaustion, moderate-high for depersonalization, and high for personal accomplishment. High emotional exhaustion was observed in younger chairs, those who worked nearly 70 hours each week, and those with less spouse/partner support. Burnout was more common in new chairs. Burnout in chairs of obstetrics and gynecology is characterized by a high level of emotional exhaustion, moderate-high depersonalization, and

  16. [The Spanish Society of Paediatric Infectious Diseases guidelines on the prevention, diagnosis and treatment of neonatal herpes simplex infections]. (United States)


    Neonatal herpes simplex virus infections are rare, but are associated with significant morbidity and mortality. Most newborns acquire herpes simplex virus infection in the peripartum period. For peripartum transmission to occur, women must be shedding the virus in their genital tracts symptomatically or asymptomatically around the time of delivery. There are evidence-based interventions in pregnancy to prevent the transmission to the newborn. Caesarean section should be performed in the presence of herpetic lesions, and antiviral prophylaxis in the last weeks of pregnancy is recommended to suppress genital tract herpes simplex virus at the time of delivery. The diagnosis and early treatment of neonatal herpes simplex virus infections require a high index of suspicion, especially in the absence of skin lesions. It is recommended to rule out herpes simplex virus infections in those newborns with mucocutaneous lesions, central nervous system involvement, or septic appearance. The prognosis of newborns with skin, eye, and/or mouth disease in the high-dose acyclovir era is very good. Antiviral treatment not only improves mortality rates in disseminated and central nervous system disease, but also improves the rates of long-term neurodevelopmental impairment in the cases of disseminated disease. Interestingly, a 6-month suppressive course of oral acyclovir following the acute infection has improved the neurodevelopmental prognosis in patients with CNS involvement. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  17. Salmonella Diagnosis and Treatment (United States)

    ... FDA) USDA Food Safety and Inspection Service Follow Salmonella RSS Diagnosis and Treatment Recommend on Facebook Tweet Share Compartir How Can Salmonella Infections Be Diagnosed? Diagnosing salmonellosis requires testing a ...

  18. Somnambulism: Diagnosis and treatment (United States)

    Bharadwaj, Rahul; Kumar, Suresh


    Somnambulism is an arousal disorder that is usually benign, self-limited and only infrequently requires treatment. Chronic sleepwalking in children has been shown to be associated with behavioral problems and poor emotional regulation. Most cases can be diagnosed with careful noting of case history and epilepsy is an important differential diagnosis. Management with pharmacological and behavioural measures is usually safe and effective. We present two cases of somnambulism that highlight the importance of the diagnosis and treatment of this condition. PMID:20711396

  19. NCI's Dr. Barry Kramer on C-SPAN Over-Diagnosis and Treatment of Cancer | Division of Cancer Prevention (United States)

    Dr. Barnett Kramer on Over-Diagnosis and Treatment of Cancer. Dr. Barnett Kramer talked about a study published in the Journal of American Medical Association on the changing the definition of cancer that could reduce unnecessary treatments for benign cancers. He also responded to telephone calls and electronic communications. |

  20. Pneumonia. Treatment and diagnosis. (United States)

    Mattila, Joshua T; Fine, Michael J; Limper, Andrew H; Murray, Patrick R; Chen, Bill B; Lin, Philana Ling


    Pneumonia remains a leading cause of morbidity and mortality despite advances in treatment and therapy. The "Pneumonia: Treatment and Diagnosis" session of the Pittsburgh International Lung Conference examined topics related to improving care of patients with pneumonia. These topics included the process and quality of care for community-acquired pneumonia (CAP), diagnosis and treatment of emerging fungal pathogens, an overview of the strengths and weaknesses of different diagnostic modalities, and an example of how basic science is exploring immunomodulatory strategies for pneumonia treatment. Systematic health care provider and institutional improvements can decrease mortality rates in CAP, particularly in patients with increasingly complex comorbidities. Aspects of current guidelines for the diagnosis and treatment of fungal pneumonia were reviewed through a series of case presentations. Proper treatment of pneumonia hinges on correct pathogen identification but is complicated by the variety of diagnostic assays with variable specificity, sensitivity, and interpretation. In addressing this topic, Dr. Patrick Murray, Ph.D., discussed a range of diagnostic tests for a variety of pathogens and guidelines for their use. In addition to the current state of CAP treatment, Bill (Beibei) Chen, M.D., Ph.D., presented a new potential therapeutic agent called forsythin, an immunomodulatory compound derived from a plant used in traditional Chinese medicine. These topics, ranging from institution-sized policy to interactions at the molecular scale, paint a broad perspective of the efforts against pneumonia.

  1. [Urticaria: diagnosis and treatment]. (United States)

    Soria, A; Francès, C


    Urticaria is a common inflammatory skin disease. It is clinically defined as the occurrence of transient papular skin and/or mucosal lesions or subcutaneous lesions called angioedema. Chronic urticaria is defined as a clinical course over more than 6weeks. Different clinical forms of urticaria can coexist in the same patient. Urticaria results of mast cell activation. The diagnosis of urticaria is based on clinical examination. An allergic etiology for acute urticaria, although rare, is always to find and remove. Chronic urticaria is not allergic. Diagnosis is based on questioning and a careful clinical examination to rule out differential diagnoses. Few diagnostic tests are necessary for diagnosis and management, and are especially useful in case of doubtful diagnosis. The treatment of urticaria is symptomatic and based on anti-H1 second generation antihistamines as first-line therapy. In some chronic urticarial, antihistamines up dosing may be necessary. In the majority of patients, this treatment is sufficient to control chronic urticaria. In case of antihistamines failure, other treatment particularly immunomodulatory treatments can be offered in specialized departments. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  2. EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses. (United States)

    Belyaev, Igor; Dean, Amy; Eger, Horst; Hubmann, Gerhard; Jandrisovits, Reinhold; Kern, Markus; Kundi, Michael; Moshammer, Hanns; Lercher, Piero; Müller, Kurt; Oberfeld, Gerd; Ohnsorge, Peter; Pelzmann, Peter; Scheingraber, Claus; Thill, Roby


    , the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment. In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis. The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person's resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a

  3. EUROPAEM EMF Guideline 2015 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses. (United States)

    Belyaev, Igor; Dean, Amy; Eger, Horst; Hubmann, Gerhard; Jandrisovits, Reinhold; Johansson, Olle; Kern, Markus; Kundi, Michael; Lercher, Piero; Mosgöller, Wilhelm; Moshammer, Hanns; Müller, Kurt; Oberfeld, Gerd; Ohnsorge, Peter; Pelzmann, Peter; Scheingraber, Claus; Thill, Roby


    environment. In the beginning, EHS symptoms often occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleeping problems, depression, lack of energy, fatigue and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to the diagnosis. The EMF exposure can be assessed by asking for typical sources like Wi-Fi access points, routers and clients, cordless and mobile phones and measurements at home and at work. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of EMF at home and in the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. Also the survival rate of children with leukemia depends on ELF magnetic field exposure at home. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports a balanced homeostasis will increase a person's resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the number of symptoms reported in the context of EMF exposures is

  4. Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study. (United States)

    Seibt, Creta Elisa; Munerato, Maria Cristina


    Syphilis is an infectious disease caused by the bacterium Treponema pallidum. Syphilis has three clinical stages and may present various oral manifestations, mainly at the secondary stage. The disease mimics other more common oral mucosa lesions, going undiagnosed and with no proper treatment. Despite the advancements in medicine toward prevention, diagnosis, and treatment syphilis remains a public health problem worldwide. In this sense, dental surgeons should be able to identify the most common manifestations of the disease in the oral cavity, pointing to the role of this professional in prevention and diagnosis. This study describes a case series of seven patients with secondary syphilis presenting different oral manifestations. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

  5. Diagnosis and treatment of impetigo. (United States)

    Cole, Charles; Gazewood, John


    Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age. The two types of impetigo are nonbullous impetigo (i.e., impetigo contagiosa) and bullous impetigo. The diagnosis usually is made clinically, but rarely a culture may be useful. Although impetigo usually heals spontaneously within two weeks without scarring, treatment helps relieve the discomfort, improve cosmetic appearance, and prevent the spread of an organism that may cause other illnesses (e.g., glomerulonephritis). There is no standard treatment for impetigo, and many options are available. The topical antibiotics mupirocin and fusidic acid are effective and may be superior to oral antibiotics. Oral antibiotics should be considered for patients with extensive disease. Oral penicillin V is seldom effective; otherwise there is no clear preference among antistaphylococcal penicillins, amoxicillin/clavulanate, cephalosporins, and macrolides, although resistance rates to erythromycin are rising. Topical disinfectants are not useful in the treatment of impetigo.

  6. Traditional preventive treatment options

    DEFF Research Database (Denmark)

    Longbottom, C; Ekstrand, K; Zero, D


    Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient...... options....

  7. Seasonal Allergies: Diagnosis, Treatment & Research (United States)

    ... this page please turn JavaScript on. Feature: Seasonal Allergies Diagnosis, Treatment & Research Past Issues / Spring 2015 Table of Contents Diagnosis Testing for Allergies Knowing exactly what you are allergic to can ...

  8. Osteoporosis: diagnosis and treatment

    International Nuclear Information System (INIS)

    Valino, J.; Mendoza, B.; Bozzola, J.; Vignolo, J.


    Osteoporosis represents an important problem in Public Health. It is defined a decrease in bone mass with changes in its microstructure and increased rich of fracture. This bone mass is under the influence of genetic, ethnic, nutrition environment and cultural factors. Usually, osteoporosis is asymptomatic until the occurrence of fracture that are the main morbidity element. Its study implies conventional radiologic methods, bone densitometry, bone remodelation markers and bone biopsy. The importance of prevention must be noted, as well as its treatment on the basis of exercise, calcium and hormonal substitution in the post menopause woman. Other drugs are vitamin D, bifosfonates, calcitonin and fluorine; the factors involved in bone growth on the course of experimentation [es

  9. Osteogenesis imperfecta: diagnosis and treatment. (United States)

    Palomo, Telma; Vilaça, Tatiane; Lazaretti-Castro, Marise


    Here we summarize the diagnosis of osteogenesis imperfecta, discuss newly discovered genes involved in osteogenesis imperfecta, and review the management of this disease in children and adults. Mutations in the two genes coding for collagen type I, COL1A1 and COL1A2, are the most common cause of osteogenesis imperfecta. In the past 10 years, defects in at least 17 other genes have been identified as responsible for osteogenesis imperfecta phenotypes, with either dominant or recessive transmission. Intravenous bisphosphonate infusions are the most widely used medical treatment. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures. However, bisphosphonates are less effective for preventing long-bone fractures. At the moment, new therapies are under investigation. Despite advances in the diagnosis and treatment of osteogenesis imperfecta, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.

  10. Dengue fever: diagnosis and treatment. (United States)

    Wiwanitkit, Viroj


    Dengue fever is a common tropical infection. This acute febrile illness can be a deadly infection in cases of severe manifestation, causing dengue hemorrhagic shock. In this brief article, I will summarize and discuss the diagnosis and treatment of this disease. For diagnosis of dengue, most tropical doctors make use of presumptive diagnosis; however, the definite diagnosis should be based on immunodiagnosis or viral study. Focusing on treatment, symptomatic and supportive treatment is the main therapeutic approach. The role of antiviral drugs in the treatment of dengue fever has been limited, but is currently widely studied.

  11. Chickenpox Prevention and Treatment (United States)

    ... Multimedia Related Links Medline Plus Shingles Prevention & Treatment Language: English Español (Spanish) Recommend on Facebook ... Prescribed by Your Doctor Español: Prevención y tratamiento Prevention The best way to prevent chickenpox is to ...

  12. Symptoms, Diagnosis & Treatment (United States)

    ... gums Sweating, especially at night Bone or joint pain Diagnosis Your doctor will perform blood tests to see ... Weakness and tiredness that don't go away Pain, swelling, or a feeling of fullness in the abdomen Diagnosis A lymph node biopsy is used to diagnose ...

  13. Traditional preventive treatment options

    DEFF Research Database (Denmark)

    Longbottom, C; Ekstrand, K; Zero, D


    conventional operative care, and since controlling the caries process prior to first restoration is the key to breaking the repair cycle and improving care for patients, future research should address the shortcomings in the current level of supporting evidence for the various traditional preventive treatment......Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient...

  14. Traditional Chinese medicine and new concepts of predictive, preventive and personalized medicine in diagnosis and treatment of suboptimal health. (United States)

    Wang, Wei; Russell, Alyce; Yan, Yuxiang


    The premise of disease-related phenotypes is the definition of the counterpart normality in medical sciences. Contrary to clinical practices that can be carefully planned according to clinical needs, heterogeneity and uncontrollability is the essence of humans in carrying out health studies. Full characterization of consistent phenotypes that define the general population is the basis to individual difference normalization in personalized medicine. Self-claimed normal status may not represent health because asymptomatic subjects may carry chronic diseases at their early stage, such as cancer, diabetes mellitus and atherosclerosis. Currently, treatments for non-communicable chronic diseases (NCD) are implemented after disease onset, which is a very much delayed approach from the perspective of predictive, preventive and personalized medicine (PPPM). A NCD pandemic will develop and be accompanied by increased global economic burden for healthcare systems throughout both developed and developing countries. This paper examples the characterization of the suboptimal health status (SHS) which represents a new PPPM challenge in a population with ambiguous health complaints such as general weakness, unexplained medical syndrome (UMS), chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS) and chronic fatigue immune dysfunction syndrome (CFIDS). We applied clinical informatic approaches and developed a questionnaire-suboptimal health status questionnaire-25 (SHSQ-25) for measuring SHS. The validity and reliability of this approach were evaluated in a small pilot study and then in a cross-sectional study of 3,405 participants in China. We found a correlation between SHS and systolic blood pressure, diastolic blood pressure, plasma glucose, total cholesterol and high-density lipoprotein (HDL) cholesterol among men, and a correlation between SHS and systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides

  15. Pertussis Diagnosis & Treatment (United States)

    ... the hospital. If Your Child Gets Treatment for Pertussis at Home Do not give cough medications unless ... from occurring. If Your Child Gets Treatment for Pertussis in the Hospital Your child may need help ...

  16. Novel preventive treatment options

    DEFF Research Database (Denmark)

    Longbottom, C; Ekstrand, K; Zero, D


    A number of novel preventive treatment options which, as with traditional methods, can be differentiated into 3 categories of prevention (primary, secondary and tertiary), have been and are being currently investigated. Those reviewed are either commercially available or appear relatively close...... of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral...

  17. Preventive Migraine Treatment (United States)

    Silberstein, Stephen D.


    Purpose of Review: This article reviews the evidence base for the preventive treatment of migraine. Recent Findings: Evidence-based guidelines for the preventive treatment of migraine have recently been published by the American Academy of Neurology (AAN) and the Canadian Headache Society (CHS), providing valuable guidance for clinicians. Strong evidence exists to support the use of metoprolol, timolol, propranolol, divalproex sodium, sodium valproate, and topiramate for migraine prevention, according to the AAN. Based on best available evidence, adverse event profile, and expert consensus, topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, Petasites (butterbur), riboflavin, coenzyme Q10, and magnesium citrate received a strong recommendation for use from the CHS. Summary: Migraine preventive drug treatments are underutilized in clinical practice. Principles of preventive treatment are important to improve compliance, minimize side effects, and improve patient outcomes. Choice of preventive treatment of migraine should be based on the presence of comorbid and coexistent illness, patient preference, reproductive potential and planning, and best available evidence. PMID:26252585

  18. Preclinical diagnosis of Alzheimer's disease: Prevention or prediction?

    Directory of Open Access Journals (Sweden)

    Ricardo Nitrini

    Full Text Available Abstract The diagnosis of Alzheimer's disease (AD for cases with dementia may be too late to allow effective treatment. Criteria for diagnosis of preclinical AD suggested by the Alzheimer's Association include the use of molecular and structural biomarkers. Preclinical diagnosis will enable testing of new drugs and forms of treatment toward achieving successful preventive treatment. But what are the advantages for the individual? To know that someone who is cognitively normal is probably going to develop AD's dementia when there is no effective preventive treatment is definitely not good news. A research method whereby volunteers are assigned to receive treatment or placebo without knowing whether they are in the control or at-risk arm of a trial would overcome this potential problem. If these new criteria are used wisely they may represent a relevant milestone in the search for a definitive treatment for AD.

  19. Pediatric Hypothyroidism: Diagnosis and Treatment. (United States)

    Wassner, Ari J


    Thyroid hormone has important physiologic functions in nearly every organ system. The critical role of thyroid hormone in growth and in physical and neurologic development lends particular importance to the prompt diagnosis and appropriate treatment of hypothyroidism in infants and children. Congenital hypothyroidism is common and has potentially devastating neurologic consequences. While the approach to diagnosis and treatment of severe congenital hypothyroidism is well established, data continue to emerge about the genetic causes, clinical significance, and prognosis of the milder forms of congenital hypothyroidism that are increasingly being diagnosed by newborn screening. Similarly, the diagnosis and treatment of severe acquired hypothyroidism is straightforward and clearly of clinical benefit, but uncertainty remains about the optimal management of mild subclinical hypothyroidism. This review summarizes current knowledge of the causes, clinical manifestations, diagnosis, treatment, and prognosis of hypothyroidism in infants and children, with a focus on recent developments and areas of uncertainty in this field.

  20. Parkinson's Disease: Diagnosis and Treatment (United States)

    ... of this page please turn JavaScript on. Feature: Parkinson's Disease Parkinson's Disease: Diagnosis and Treatment Past Issues / Winter 2014 Table of Contents Medications for Parkinson's disease can help many patients live productive lives and ...

  1. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. (United States)

    Ketteler, Markus; Block, Geoffrey A; Evenepoel, Pieter; Fukagawa, Masafumi; Herzog, Charles A; McCann, Linda; Moe, Sharon M; Shroff, Rukshana; Tonelli, Marcello A; Toussaint, Nigel D; Vervloet, Marc G; Leonard, Mary B


    The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update and the original publication are intended to assist practitioners caring for adults with CKD and those receiving long-term dialysis. Development of the guideline update followed an explicit process of evidence review and appraisal. The approach adopted by the Work Group and the evidence review team was based on systematic reviews of relevant trials, appraisal of the quality of the evidence, and rating of the strength of recommendations according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Searches of the English-language literature were conducted through September 2015 and were supplemented with targeted searches through February 2017. Final modification of the guidelines was informed by a public review process involving numerous stakeholders, including patients, subject matter experts, and industry and national organizations. The update process resulted in the revision of 15 recommendations. This synopsis focuses primarily on recommendations for diagnosis of and testing for CKD-MBD and treatment of CKD-MBD that emphasizes decreasing phosphate levels, maintaining calcium levels, and addressing elevated parathyroid hormone levels in adults with CKD stage G3a to G5 and those receiving dialysis. Key elements include basing treatment on trends in laboratory values rather than a single abnormal result and being cautious to avoid hypercalcemia when treating secondary hyperparathyroidism.

  2. Diagnosis and treatment of haemorrhoids

    DEFF Research Database (Denmark)

    Buntzen, Steen; Christensen, Peter Quist; Khalid, Ali


    These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II...... haemorrhoids are treated conservatively, but surgery may be considered in a few cases with pronounced symptoms. In these cases chirurgia minor, Doppler guided dearterilization procedures or stapled haemorrhoidopexy are recommended. In grade III and IV Doppler guided dearterilization procedures, stapled...

  3. Impetigo: diagnosis and treatment. (United States)

    Hartman-Adams, Holly; Banvard, Christine; Juckett, Gregory


    Impetigo is the most common bacterial skin infection in children two to five years of age. There are two principal types: nonbullous (70% of cases) and bullous (30% of cases). Nonbullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the face and extremities. Impetigo primarily affects the skin or secondarily infects insect bites, eczema, or herpetic lesions. Bullous impetigo, which is caused exclusively by S. aureus, results in large, flaccid bullae and is more likely to affect intertriginous areas. Both types usually resolve within two to three weeks without scarring, and complications are rare, with the most serious being poststreptococcal glomerulonephritis. Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical. Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not. Natural therapies such as tea tree oil; olive, garlic, and coconut oils; and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options. Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone. Topical disinfectants are inferior to antibiotics and should not be used. Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, with methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus all documented. Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections. Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections. Trimethoprim/sulfamethoxazole covers methicillin-resistant S

  4. Pedophilia-Themed Obsessive-Compulsive Disorder: Assessment, Differential Diagnosis, and Treatment with Exposure and Response Prevention. (United States)

    Bruce, Simone Leavell; Ching, Terence H W; Williams, Monnica T


    Fears of sexually harming children are fairly common among clients suffering from obsessive-compulsive disorder (OCD), yet these symptoms are largely unrecognized and frequently misdiagnosed by mental health professionals. Specifically, clients with pedophilia-themed OCD (P-OCD) experience excessive worries and distressing intrusive thoughts about being sexually attracted to, and sexually violating, children. Expressing these concerns may provoke misjudgments from uninformed mental health professionals that a client is presenting instead with pedophilic disorder. This misdiagnosis and subsequent improper interventions can then contribute to increased fear, anxiety, and in many cases, depression, in affected clients. Therefore, it is imperative that mental health professionals first possess a good understanding of this common manifestation of OCD. As such, in this article, we described obsessions and compulsions typical of P-OCD, in order to inform the reader of the distinctive differences between P-OCD and pedophilic disorder. Information about how to assess for P-OCD symptoms is then provided, followed by suggestions on how to tailor aspects of exposure and response prevention to treat this specific form of OCD.



    Due to the implementation of the International Bank for Reconstruction and Development (IBRD) loan project "Prevention, diagnosis, treatment of tuberculosis and AIDS", a "Tuberculosis" component that is an addition to the national tuberculosis control program in 15 subjects of the Russian Federation, followed up by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, the 2005-2008 measures stipulated by the Project have caused substantial changes in the organization of tuberculosis control: implementation of Orders Nos. 109, 50, and 690 and supervision of their implementation; modernization of the laboratories of the general medical network and antituberbulosis service (404 kits have been delivered for clinical diagnostic laboratories and 12 for bacteriological laboratories, including BACTEC 960 that has been provided in 6 areas); 91 training seminars have been held at the federal and regional levels; 1492 medical workers have been trained in the detection, diagnosis, and treatment of patients with tuberculosis; 8 manuals and guidelines have been prepared and sent to all areas. In the period 2005-2008, the tuberculosis morbidity and mortality rates in the followed-up areas reduced by 1.2 and 18.6%, respectively. The analysis of patient cohorts in 2007 and 2005 revealed that the therapeutic efficiency evaluated from sputum smear microscopy increased by 16.3%; there were reductions in the proportion of patients having ineffective chemotherapy (from 16.1 to 11.1%), patients who died from tuberculosis (from 11.6 to 9.9%), and those who interrupted therapy ahead of time (from 11.8 to 7.8%). Implementation of the IBR project has contributed to the improvement of the national strategy and the enhancement of the efficiency of tuberculosis control.

  6. Trichotillomania: Assessment, Diagnosis, and Treatment (United States)

    Kress, Victoria E. White; Kelly, Brandy L.; McCormick, Laura J.


    This article examines the assessment, diagnosis, and treatment of trichotillomania (the recurrent desire to pull out one's hair). The authors provide a brief review both of proposed etiologies of trichotillomania and of the diagnostic and assessment issues related to this disorder, and they discuss interventions and treatments that have been shown…

  7. Rosacea: Diagnosis and Treatment. (United States)

    Oge', Linda K; Muncie, Herbert L; Phillips-Savoy, Amanda R


    Rosacea is a chronic facial skin condition of unknown cause. It is characterized by marked involvement of the central face with transient or persistent erythema, telangiectasia, inflammatory papules and pustules, or hyperplasia of the connective tissue. Transient erythema, or flushing, is often accompanied by a feeling of warmth. It usually lasts for less than five minutes and may spread to the neck and chest. Less common findings include erythematous plaques, scaling, edema, phymatous changes (thickening of skin due to hyperplasia of sebaceous glands), and ocular symptoms. The National Rosacea Society Expert Committee defines four subtypes of rosacea (erythematotelangiectatic, papulopustular, phymatous, and ocular) and one variant (granulomatous). Treatment starts with avoidance of triggers and use of mild cleansing agents and moisturizing regimens, as well as photoprotection with wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor of 30). For inflammatory lesions and erythema, the recommended initial treatments are topical metronidazole or azelaic acid. Once-daily brimonidine, a topical alpha-adrenergic receptor agonist, is effective in reducing erythema. Papulopustular rosacea can be treated with systemic therapy including tetracyclines, most commonly subantimicrobial-dose doxycycline. Phymatous rosacea is treated primarily with laser or light-based therapies. Ocular rosacea is managed with lid hygiene, topical cyclosporine, and topical or systemic antibiotics.

  8. Potential of the Antibody Against cis-Phosphorylated Tau in the Early Diagnosis, Treatment, and Prevention of Alzheimer Disease and Brain Injury. (United States)

    Lu, Kun Ping; Kondo, Asami; Albayram, Onder; Herbert, Megan K; Liu, Hekun; Zhou, Xiao Zhen


    Alzheimer disease (AD) and chronic traumatic encephalopathy (CTE) share a common neuropathologic signature-neurofibrillary tangles made of phosphorylated tau-but do not have the same pathogenesis or symptoms. Although whether traumatic brain injury (TBI) could cause AD has not been established, CTE is shown to be associated with TBI. Until recently, whether and how TBI leads to tau-mediated neurodegeneration was unknown. The unique prolyl isomerase Pin1 protects against the development of tau-mediated neurodegeneration in AD by converting the phosphorylated Thr231-Pro motif in tau (ptau) from the pathogenic cis conformation to the physiologic trans conformation, thereby restoring ptau function. The recent development of antibodies able to distinguish and eliminate both conformations specifically has led to the discovery of cis-ptau as a precursor of tau-induced pathologic change and an early driver of neurodegeneration that directly links TBI to CTE and possibly to AD. Within hours of TBI in mice or neuronal stress in vitro, neurons prominently produce cis-ptau, which causes and spreads cis-ptau pathologic changes, termed cistauosis. Cistauosis eventually leads to widespread tau-mediated neurodegeneration and brain atrophy. Cistauosis is effectively blocked by the cis-ptau antibody, which targets intracellular cis-ptau for proteasome-mediated degradation and prevents extracellular cis-ptau from spreading to other neurons. Treating TBI mice with cis-ptau antibody not only blocks early cistauosis but also prevents development and spreading of tau-mediated neurodegeneration and brain atrophy and restores brain histopathologic features and functional outcomes. Thus, cistauosis is a common early disease mechanism for AD, TBI, and CTE, and cis-ptau and its antibody may be useful for early diagnosis, treatment, and prevention of these devastating diseases.

  9. Diagnosis, Prevention and Management of Postoperative ...

    African Journals Online (AJOL)

    Diagnosis, Prevention and Management of Postoperative Pulmonary Edema. ... period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post.extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure.

  10. Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment (United States)

    Torres, Patrick A.; Helmstetter, John A.; Kaye, Adam M.; Kaye, Alan David


    Background Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. Methods This review focuses on the epidemiology, pathophysiology, causes, presentation, diagnosis, complications, management, and anesthetic considerations related to rhabdomyolysis. Results Any form of muscle damage––and by extension any entity that causes muscle damage––can initiate rhabdomyolysis. One of the most important treatment goals when rhabdomyolysis is suspected is avoiding acute kidney injury. Conclusion All clinicians should be aware of common causes, diagnosis, and treatment options. PMID:25829882

  11. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America

    NARCIS (Netherlands)

    Hooton, Thomas M.; Bradley, Suzanne F.; Cardenas, Diana D.; Colgan, Richard; Geerlings, Suzanne E.; Rice, James C.; Saint, Sanjay; Schaeffer, Anthony J.; Tambayh, Paul A.; Tenke, Peter; Nicolle, Lindsay E.


    Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA-UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic

  12. TBI Symptoms, Diagnosis, Treatment, Prevention (United States)

    ... few minutes); also, headache, confusion, lightheadedness, dizziness, blurred vision, ringing in the ears, bad taste in the mouth, fatigue (including changed sleep patterns), behavior or mood swings, trouble with memory and concentration. Moderate or severe: As above, but ...

  13. Cardiorenal Syndrome: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    O.O. Melnyk


    Full Text Available In the diagnosis of cardiorenal syndrome (CRS, the biological markers are widely used, they can be applied to identify the pathophysiological stages of CRS, to assess the amount of risk, prognosis and outcome, as well as to monitor the effectiveness of treatment. CRS therapy includes diuretics, vasodilators, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, nitrates and cardiac glycosides. One of the most effective methods of CRS treatment is the use of renal replacement therapy.

  14. Recomendaciones para la prevención, diagnóstico y tratamiento de LA EPOC en la Argentina Guidelines for COPD prevention, diagnosis and treatment in Argentina

    Directory of Open Access Journals (Sweden)

    Juan Carlos Figueroa Casas


    .Since morbidity, mortality and socioeconomic costs from Chronic Obstructive Pulmonary Disease (COPD are widely increasing, a group of respiratory medicine specialists was summoned by the AAMR to update basic knowledge on COPD and to issue recommendations for its prevention, diagnosis and treatment. The authors review the definition of COPD together with current knowledge on pathophysiology. Clinical presentation, functional evaluation and imaging are summarized. Early diagnosis through pulmonary function tests -mainly spirometry- and the role of smoking cessation are stressed. Smoking cessation strategies are described as well as pharmacological and non-pharmacological treatment. Long acting bronchodilators are considered the first pharmacological option for treatment due to its effectiveness and patient compliance. Inhaled corticosteroids are indicated in combination with long-acting bronchodilators in patients who present persistent airway obstruction associated with frequent exacerbations since they reduce their number although further studies are needed to confirm their cost/benefit. Annual influenza vaccination is recommended in all patients. In the non-pharmacological section, surgery for emphysema is suggested in very specific cases. Respiratory rehabilitation is a useful tool for patients with daily activities limitation. Long-term oxygen therapy at home improves survival in patients with severe chronic hypoxemia. Non-invasive home ventilation in chronic patients has limited indications in specific subgroups. Acute exacerbations should be aggressively treated with bronchodilators, oxygen, antibiotics, corticosteroids and eventually mechanical ventilation, as invasive as not invasive respiratory support. The importance of public education as well as of individual patients and their families is deemed essential in the prevention and treatment of the disease.

  15. [Cellulite - causes, prevention, treatment ]. (United States)

    Janda, Katarzyna; Tomikowska, Anna


    Cellulite is a multifactorial etiology ailment. It changes the skin topography by the formation of the skin surface's appearance, changes described as "orange peel". This prob- lem concerns 85-98% of women, and for them it is one of the most intolerable aesthetic imperfections. In the past few years the interest of scientists in this problem has clearly increased. Several theories on the pathophysiology of cel- lulite have been produced A number of different thera- peutic regimens have been developed using modern tech- nology. However, despite the many treatment options for cellulite, it is extremely important that patients should be aware that only multidirectional treatment can bring sat- isfactory results. The aim of this review was to describe the causes of cellulite, and its prevention and treatment.

  16. [Lymphoedema--diagnosis and treatment]. (United States)

    Cisek, Paweł; Starosławska, Elzbieta; Kieszko, Dariusz; Patyra, Krzysztof; Surdyka, Dariusz; Kolak, Agnieszka; Kordzińska-Cisek, Izabela; Czubacka-Szewczyk, Magdalena; Mocarska, Agnieszka; Burdan, Franciszek


    Lymphoedema is a common complication of oncological treatment. Various methods of imaging are used in its diagnosing and monitoring. However, presently lymphoscintigraphy has become the golden standard. A physical examination and detailed medical history also play a very important role. There are still no effective methods of prevention and treatment of lymphoedema in spite of medical progress. The treatment requires a multidisciplinary approach with the use of various methods of physiotherapy (pressure therapy, pneumatic pumps and electric high-voltage treatment), pharmacology and surgery. Patient's education and suitable physical exercises are also significant.

  17. Novel preventive treatment options

    DEFF Research Database (Denmark)

    Longbottom, C; Ekstrand, K; Zero, D


    to that point. These include: approximal sealants; fluoride applications, including slow-release devices; measures to help remineralize demineralized tissue, including 3 different methods of delivering amorphous calcium phosphate; measures to help modify the biofilm to reduce the cariogenic challenge, including...... of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral...

  18. Hyperprolactinemia: causes, diagnosis, and treatment

    International Nuclear Information System (INIS)

    Karasek, M.; Pawlikowski, M.; Lewinski, A.


    The basic data on hyperprolactinemia (i.e. an excess of PRL above a reference laboratory's upper limits), the most common endocrine disorder of the hypothalamic-pituitary axis are given in this review. The following issues are discussed: regulation of prolactin (Prl) secretion, definition of hyperprolactinemia, its etiology and pathogenesis as well as its symptoms, diagnosis, and treatment (including medical and surgical therapy). It should be stressed that finding of elevated PRL serum concentrations constitute the beginning of diagnostic procedure and, after exclusion of physiologic, pharmacologic, and other organic causes of increased PRL levels, should be followed by detailed diagnosis including MRI. In patients in whom hyperprolactinemia has been confirmed the treatment with dopamine agonists (with prevalence of cabergoline, followed by quinagoline) is currently considered first-choice therapy. Surgery should be performed only in the patients resistant or intolerant to these agents, or in patients who refuse long-term therapy. (author)

  19. Diagnosis and Treatment of Neurocysticercosis

    Directory of Open Access Journals (Sweden)

    Christina M. Coyle


    Full Text Available Neurocysticercosis, the infection caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy worldwide. This has primarily been a disease that remains endemic in low-socioeconomic countries, but because of increased migration neurocysticercosis is being diagnosed more frequently in high-income countries. During the past three decades improved diagnostics, imaging, and treatment have led to more accurate diagnosis and improved prognosis for patients. This article reviews the current literature on neurocysticercosis, including newer diagnostics and treatment developments.

  20. Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention (United States)

    Pass, Robert F.; Arav-Boger, Ravit


    Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection. PMID:29560263

  1. [Prevention, diagnosis and treatment of iatrogennic lesions of biliary tract during laparoscopic cholecystectomy. Management of papila injury after invasive endoscopy. Part 1. Prevention and diagnosis of bile duct injuries]. (United States)

    Sváb, J; Pesková, M; Krska, Z; Gürlich, R; Kasalický, M


    Endoscopic invasive procedures in 70th and 80th years leaded to decrease reoperations on biliary tree. Iatrogenic injury of the biliary tract have increased in incidence in the first decade with the introduction of laparoscopic cholecystectomy. Athough a number of factors have been identified with a high risk of injury ( and number of technical steps have been emphasized to avoid these injury, the incidence of the bile duct injury has reached at least double the rate observed with open cholecystectomy. Cholecystectomy is most frequently performed abdominal operation and the most serious complication associated with this procedure is accidental injury to the common bile duct (0.3-0.4%). This preventable technical error has tradicionally been thought to occur in one or more of three situations: 1. When the operator attempts to clip or ligate a bleeding cystic artery and also clips the common hepatic duct (Fig. 3a). 2. When too much traction has been exerted on the gallbladder so that the common bile duct has tented up into an albow, which was either tied off with ligature or clipped (Fig. 3b). 3. When anatomic anomalies were not recognized and the wrong structure is divided, for example, when the cystic duct winds anterior to the common bile duct and enters on the left side, or when the cystic duct joins the right hepatic duct rather than the junction of the common hepatic and the common bile ducts (Fig. 1, 2, 3cd). In anatomical incertain cases is discussed about cholangiography and cholecystocholangiography during laparoscopy cholecystectomy. Most patients sustained a bile duct injury are recognized in the weeks folloving laparoscopic cholecystectomy. Careful preoperative preparation should include control of sepsis by draining any bile collections or fistulas and komplete cholangiography. Long-term results are best achieved in specialized hepatobiliary centres performing biliary reconstruction with a Roux-Y hepaticojejunostomy. Success rates over 90% have been


    Directory of Open Access Journals (Sweden)

    Pasca Luminita Aurelia


    Full Text Available Sarcopenia is defined as the age-related loss of skeletal muscle mass and decline of function. The causes of sarcopenia are multi-factorial. The diagnosis of sarcopenia should be considered in all older patients who present with declines in physical function, because of potential consequences for the development of frailty and disability. There are numerous techniques to assess muscle mass, muscle strength and physical performance. Treatment consists of nutritional (macro- and micronutrients and physical activity (resistance exercise regimens adapted to person. There is an emerging role for testosterone and anabolic steroids in severe sarcopenia.

  3. Problems of diagnosis and treatment of echinococcosis

    Directory of Open Access Journals (Sweden)

    Тунзала Али кызы Велиева


    disease are saved in the patient's body small residual cyst, inaccessible modern instrumental methods of diagnosis; preservation of fibrous tissue capsule and pericystic embedded germ cells that can transform into the cyst; seeding germ elements during the operation. Relapses of the disease usually associated with the colonization of the abdominal cavity with the cysts rupture, incomplete removal of the child bubbles, technical errors in surgery. Therefore, one of the most pressing issues is the chemoprophylaxis echinococcosis recurrence after surgical treatment.Conclusion. The difficulties caused by polymorphism of clinical diagnosis of symptoms and the lack of adequate diagnosis. Frequent recurrence of echinococcosis (20.4 % after surgery indicates the need for preventive treatment of disease

  4. Turco's injury: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Ana Paula Simões da Silva


    Full Text Available The aim of this study was to alert doctors to the existence of Turco's injury and discus the existing treatments that have been described in the worldwide literature. A bibliographic survey of Lisfranc's injury and Turco's injury covering from 1985 to 2013 was conducted in the SciELO and PubMed databases. Among the 193 articles, those relating to bone-ligament injuries of the Lisfranc joint and high-energy trauma were excluded, as were the case reports. The patients selected were professional or amateur athletes who solely presented a ligament injury to the Lisfranc joint (Turco's injury, which was diagnosed from the history, physical examination, radiographs and magnetic resonance images. Non-athletic patients and those with associated bone injuries were excluded (10. According to the injury classification, the patients were treated by means of either an open or a closed procedure and then a standard rehabilitation protocol. Out of the 10 patients, five underwent conservative treatment and five underwent surgical treatment using different techniques and synthesis materials. We obtained two poor results, one satisfactory, five good and two excellent. We conclude that the correct diagnosis has a direct influence on the treatment and on the final result obtained, and that lack of knowledge of this injury is the main factor responsible for underdiagnosing Turco's injury. There is a need for randomized prospective studies comparing the types of synthesis and evolution of treated cases, in order to define the best treatment for this injury.

  5. Sunburn: Treatment and Prevention (United States)

    ... 12 mos.) Toddler 1-3yrs. Preschool 3-5yrs Grade School 5-12yrs. Teen 12-18yrs. Young Adult 18-21yrs. Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

  6. Vulvodynia. Definition, diagnosis and treatment

    DEFF Research Database (Denmark)

    Petersen, Christina Damsted; Lundvall, Lene; Kristensen, Ellids


    Vulvodynia is a chronic painful disorder with an estimated prevalence of 9-12%. A rising incidence of the condition constitutes a growing problem. This has lead to an increased focus on etiology and treatment, while the definition also requires attention. Previous assumptions stating that the pro......Vulvodynia is a chronic painful disorder with an estimated prevalence of 9-12%. A rising incidence of the condition constitutes a growing problem. This has lead to an increased focus on etiology and treatment, while the definition also requires attention. Previous assumptions stating...... that the problem is solely a psychological disorder have been abandoned, because inflammatory mechanisms and genetic factors have been found to be involved in the pathogenesis as well as psychosexual contributors. This article describes the terminology and definition of the condition, theories on patho......-physiological mechanisms underlying the disorder, methods of diagnosis and evidence and recommendations on clinical management. A critical examination of the literature regarding vulvodynia reveals numerous strategies and recommendations for treatment, many of which are not evidence-based, and a lack of effective...

  7. Childhood Tuberculosis: Epidemiology, Diagnosis, Treatment, and Vaccination

    Directory of Open Access Journals (Sweden)

    Kuo-Sheng Tsai


    Full Text Available Despite the existence of a government-run tuberculosis (TB control program, the current nationwide burden of TB continues to be a public health problem in Taiwan. Intense current and previous efforts into diagnostic, therapeutic, and preventive interventions have focused on TB in adults, but childhood TB has been relatively neglected. Children are particularly vulnerable to severe disease and death following infection, and children with latent infections become reservoirs for future transmission following disease reactivation in adulthood, thus fueling future epidemics. Additional research, understanding, and prevention of childhood TB are urgently needed. This review assesses the epidemiology, diagnosis, treatment, and relevant principles of TB vaccine development and presents efficacy data for the currently licensed vaccines.

  8. Malaria prevention and treatment

    African Journals Online (AJOL)

    mask the disease and make diagnosis difficult. Should malaria then develop, it is allegedly an easy matter to ... Wear garments that fully cover arms and legs when outdoors between sunset and sunrise. • Light cotton ..... 2004; 329(7476) : 1212. 10. Nosten F, Brasseur P. Combination ther- apy for malaria: the way forward?

  9. Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research (United States)

    ... of this page please turn Javascript on. Feature: Glaucoma Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research Past Issues / Fall 2009 Table of Contents Symptoms and Diagnosis Glaucoma can develop in one or both eyes. Often ...

  10. Current Thoughts in Fungal Keratitis: Diagnosis and Treatment (United States)

    Ansari, Zubair; Miller, Darlene; Galor, Anat


    Fungal keratitis remains a challenging and often elusive diagnosis in geographic regions where it is endemic. Marred by delays in diagnosis, the sequelae of corneal fungal infections, though preventable, can be irreversible. Recent studies and advances in the arena have broadened the approach and treatment to mycotic keratitis. This review will discuss current diagnostic modalities of fungal keratitis and will particularly focus on treatment regimens. It will also explore future therapeutic models and critique the potential benefit of each. PMID:24040467

  11. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults

    Directory of Open Access Journals (Sweden)

    Josep A. Capdevila


    Full Text Available The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications.

  12. Food addiction-diagnosis and treatment. (United States)

    Dimitrijević, Ivan; Popović, Nada; Sabljak, Vera; Škodrić-Trifunović, Vesna; Dimitrijević, Nina


    In this article we summarized the recent research of the food addiction, diagnosis, treatment and prevention, which is carried out in this area. The concept of food addiction is new and complex, but proven to be very important for understanding and solving the problem of obesity. First part of this paper emphasizes the neurological studies, whose results indicate the similarity of brain processes that are being activated during drug abuse and during eating certain types of food. In this context, different authors speak of "hyper-palatable", industrial food, saturated with salt, fat and sugar, which favor an addiction. In the section on diagnostic and instruments constructed for assessing the degree of dependence, main diagnostic tool is standardized Yale Food Addiction Scale constructed by Ashley Gearhardt, and her associates. Since 2009, when it was first published, this scale is used in almost all researches in this area and has been translated into several languages. Finally, distinguish between prevention and treatment of food addiction was made. Given that there were similarities with other forms of addictive behavior, the researchers recommend the application of traditional addiction treatment.

  13. ECIL guidelines for the prevention, diagnosis and treatment of BK polyomavirus-associated haemorrhagic cystitis in haematopoietic stem cell transplant recipients. (United States)

    Cesaro, Simone; Dalianis, Tina; Hanssen Rinaldo, Christine; Koskenvuo, Minna; Pegoraro, Anna; Einsele, Hermann; Cordonnier, Catherine; Hirsch, Hans H


    To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Review of English literature and evidence-based recommendations by expert consensus. BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use. BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email:

  14. Genetics, Disease Prevention and Treatment (United States)

    Skip to main content FAQ About Genetics, Disease Prevention and Treatment Enter Search Term(s): Español Research Funding An Overview Bioinformatics Current Grants Education and Training Funding Extramural Research News ...

  15. Lung cancer: diagnosis, treatment principles, and screening. (United States)

    Latimer, Kelly M; Mott, Timothy F


    Lung cancer is classified histologically into small cell and non-small cell lung cancers. The most common symptoms of lung cancer are cough, dyspnea, hemoptysis, and systemic symptoms such as weight loss and anorexia. High-risk patients who present with symptoms should undergo chest radiography. If a likely alternative diagnosis is not identified, computed tomography and possibly positron emission tomography should be performed. If suspicion for lung cancer is high, a diagnostic evaluation is warranted. The diagnostic evaluation has three simultaneous steps (tissue diagnosis, staging, and functional evaluation), all of which affect treatment planning and determination of prognosis. The least invasive method possible should be used. The diagnostic evaluation and treatment of a patient with lung cancer require a team of specialists, including a pulmonologist, medical oncologist, radiation oncologist, pathologist, radiologist, and thoracic surgeon. Non-small cell lung cancer specimens are tested for various mutations, which, if present, can be treated with new targeted molecular therapies. The family physician should remain involved in the patient's care to ensure that the values and wishes of the patient and family are considered and, if necessary, to coordinate end-of-life care. Early palliative care improves quality of life and may prolong survival. Family physicians should concentrate on early recognition of lung cancer, as well as prevention by encouraging tobacco cessation at every visit. The U.S. Preventive Services Task Force recommends lung cancer screening using low-dose computed tomography in high-risk patients. However, the American Academy of Family Physicians concludes that the evidence is insufficient to recommend for or against screening. Whether to screen high-risk patients should be a shared decision between the physician and patient.

  16. Tuberculosis prevention and treatment. (United States)

    Toth, Anita; Fackelmann, Janice; Pigott, Wendy; Tolomeo, Ornella


    Tuberculosis (TB) is one of the oldest known diseases and has claimed more lives than any other Today, about one-third of the world's population is infected with TB. In 2003, 1,379 cases of new, active and relapsed TB were reported in Canada. TB is caused by Mycobacterium tuberculosis. Only 10 per cent of infected individuals will develop active TB. Pulmonary TB can be spread by an infectious person through the aerosolization of droplets when coughing, talking, spitting, sneezing or singing. Symptoms of pulmonary TB are a cough with or without sputum production lasting at least three weeks, chest pain, hemoptysis, fever, night sweats, weight loss, lack of appetite, chills and weakness. Extrapulmonary TB is generally not associated with person-to-person spread. Common sites include the throat, lymph nodes, abdomen, intestines, long bones of the legs, spine, kidneys, bladder, skin, eyes and meninges. The risk factors for TB infection and disease include close contact with an active pulmonary TB case, HIV infection or AIDS, inactive disease not adequately treated, low income, underlying medical condition, homelessness, alcoholism, injection drug use, aboriginal background or occupation in health care. Risk settings include travel or residence in an endemic area or work or residence in a correctional facility, shelter, rooming house, residential facility, hospital or long-term care facility. Nurses need to advocate for the prompt diagnosis and isolation of suspected and confirmed TB cases. Knowing when to institute such measures as isolation in a negative pressure room, using respirator masks and limiting interpersonal contacts is vital to the nursing care of TB patients. In addition, the role of the public health department needs to be understood; for example, all jurisdictions have legislated requirements for reporting new positive TB skin tests to public health.

  17. Diagnosis and treatment of ampullary tumors

    Directory of Open Access Journals (Sweden)

    YIN Tao


    Full Text Available Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site, a deep location, and hidden symptoms. Sometimes a qualitative diagnosis cannot be made. Based on the experience in the treatment of ampullary tumors for many years in our center, this article summarizes the features of ampullary tumors from the aspects of clinical manifestations, diagnosis, treatment, and prognosis, especially the issues regarding imaging evaluation of ampullary tumors, selection of surgical procedure, and prognosis. An early diagnosis is the key to the treatment of ampullary tumors, and early identification and treatment of lesions have great impacts on patients′ prognosis. Accurate preoperative imaging evaluation, a professional diagnosis and treatment team, accurate preoperative and intraoperative pathological analysis, and implementation of reasonable therapeutic strategy are the key to patients′ recovery.

  18. Gastric cancer: prevention, screening and early diagnosis. (United States)

    Pasechnikov, Victor; Chukov, Sergej; Fedorov, Evgeny; Kikuste, Ilze; Leja, Marcis


    Gastric cancer continues to be an important healthcare problem from a global perspective. Most of the cases in the Western world are diagnosed at late stages when the treatment is largely ineffective. Helicobacter pylori (H. pylori) infection is a well-established carcinogen for gastric cancer. While lifestyle factors are important, the efficacy of interventions in their modification, as in the use of antioxidant supplements, is unconvincing. No organized screening programs can be found outside Asia (Japan and South Korea). Although several screening approaches have been proposed, including indirect atrophy detection by measuring pepsinogen in the circulation, none of them have so far been implemented, and more study data is required to justify any implementation. Mass eradication of H. pylori in high-risk areas tends to be cost-effective, but its adverse effects and resistance remain a concern. Searches for new screening biomarkers, including microRNA and cancer-autoantibody panels, as well as detection of volatile organic compounds in the breath, are in progress. Endoscopy with a proper biopsy follow-up remains the standard for early detection of cancer and related premalignant lesions. At the same time, new advanced high-resolution endoscopic technologies are showing promising results with respect to diagnosing mucosal lesions visually and targeting each biopsy. New histological risk stratifications (classifications), including OLGA and OLGIM, have recently been developed. This review addresses the current means for gastric cancer primary and secondary prevention, the available and emerging methods for screening, and new developments in endoscopic detection of early lesions of the stomach.

  19. Reflex syncope: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Richard Sutton


    Full Text Available For the diagnosis of reflex syncope, diligent history-building with the patient and a witness is required. In the Emergency Department (ED, the assessment of syncope is a challenge which may be addressed by an ED Observation Unit or by a referral to a Syncope Unit. Hospital admission is necessary for those with life-threatening cardiac conditions although risk stratification remains an unsolved problem. Other patients may be investigated with less urgency by carotid sinus massage (>40 years, tilt testing, and electrocardiogram loop recorder insertion resulting in a clear cause for syncope. Management includes, in general terms, patient education, avoidance of circumstances in which syncope is likely, increase in fluid and salt consumption, and physical counter-pressure maneuvers. In older patients, those that will benefit from cardiac pacing are now well defined. In all patients, the benefit of drug therapy is often disappointing and there remains no ideal drug. A role for catheter ablation may emerge for the highly symptomatic reflex syncope patient. Keywords: Cardiac pacing, Catheter ablation, Diagnosis, Drugs, Management, Reflex syncope

  20. Diagnosis and treatment of urethritis in men. (United States)

    Brill, John R


    Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in first-void urine, or at least 10 white blood cells per high-power field in urine sediment. The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Racial disparities in the prevalence of sexually transmitted infections persist in the United States, with rates of gonorrhea 40 times higher in black adolescent males than in white adolescent males. Recent studies have focused on identifying causes of nongonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species. Less common pathogens identified in patients with urethritis include Trichomonas species, adenovirus, and herpes simplex virus. History and examination findings can help distinguish urethritis from other urogenital syndromes, such as epididymitis, orchitis, and prostatitis. The goals of treatment include alleviating symptoms; preventing complications in the patient and his sexual partners; reducing the transmission of coinfections (particularly human immunodeficiency virus); identifying and treating the patient's contacts; and encouraging behavioral changes that will reduce the risk of recurrence. The combination of azithromycin or doxycycline plus ceftriaxone or cefixime is considered first-line empiric therapy in patients with urethritis. Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states. There is an association between urethritis and an increased human immunodeficiency virus concentration in semen.

  1. Studies on asymptomatic malaria, prevention and treatment seeking ...

    African Journals Online (AJOL)

    Studies on asymptomatic malaria, prevention and treatment seeking behaviours in Abeokuta, south-west Nigeria. ... Self-diagnosis for the disease was more common (60.8%) among the participants, compared to other measures; seeking laboratory test (26.5%) and clinical diagnosis (9.1%). A good proportion of the ...

  2. Patellar Tendinopathy: Diagnosis and Treatment. (United States)

    Figueroa, David; Figueroa, Francisco; Calvo, Rafael


    Patellar tendinopathy is a common cause of pain in athletes' knees. Historically, it has been related to jumping sports, such as volleyball and basketball. Repetitive jumping generates a considerable load of energy in the extensor mechanism, leading to symptoms. The main pathophysiologic phenomenon in patellar tendinopathy is tendinosis, which is a degenerative disorder rather than an inflammatory disorder; therefore, the other popular term for this disease, tendinitis, is not appropriate. The nonsurgical treatment of patellar tendinopathy is focused on eccentric exercises and often has good results. Other experimental options, with variable levels of evidence, are available for recalcitrant cases. Surgical treatment is indicated for cases that are refractory to nonsurgical treatment. Open or arthroscopic surgery can be performed; the two methods are comparable, but arthroscopic surgery results in a faster recovery time.

  3. Autoimmune hepatitis : Pathogenesis, diagnosis and treatment

    NARCIS (Netherlands)

    van den Berg, AP

    Background: Autoimmune hepatitis (AIH) is a chronic necro-inflammatory disease of the liver. Early recognition is important in order to prevent the development of cirrosis. This review discusses recent developments in the fields of diagnosis, pathophysiology and management of AIH. Methods: Relevant

  4. Biloma: radiologic diagnosis and treatment

    International Nuclear Information System (INIS)

    Kim, Hong; Woo, Yung Hoon; Woo, Seong Ku


    The localized intraabdominal bile collection or biloma has recently been diagnosed in increased frequently due to the wide spread use of US, CT, DISIDA scintigram, and radiologically guided percutaneous needle aspiration with or without subsequent catheter drainage. The underlying cause of biloma is trauma or iatrogenic injury which includes abdominal surgery, percutaneous drainage or PTC. We experience 20 patients with 22 biloma diagnostically confirmed by DISIDA scan, image-guided needle aspiration, percutaneous catheter drainage and / or operation. Of the 22 biloma, 7 were intrahepatic and 15 were extrahepatic. Of the 15 extrahepatic biloma, 7 were in partially hepatectomized bed, 3 were subhepatic, 3 were right subphrenic and 1 was subcapsular. We were able to determine the infectivity in 16 biloma and of these 12 biloma were found to be infected. Percutaneous drainage was performed on 20 biloma in 18 patients : by a needle aspiration with irrigation on 2 patient and by percutaneous catheter drainage on 18 bilomas. Overall success rate of the drainage was 90%. Cause of the two failures were CHD stone with choledochoduodenal fistula and recurrent hemobilia with acute cholecystitis. We describe the processes in reaching the diagnosis of biloma, propensity of biloma to purulent intrahepatic or perihepatic abscess formation, and the necessity of percutaneous radiologic catheter drainage as an optional management

  5. Childhood Asthma: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Wim M. van Aalderen


    Full Text Available Many children suffer from recurrent coughing, wheezing and chest tightness. In preschool children one third of all children have these symptoms before the age of six, but only 40% of these wheezing preschoolers will continue to have asthma. In older school-aged children the majority of the children have asthma. Quality of life is affected by asthma control. Sleep disruption and exercised induced airflow limitation have a negative impact on participation in sports and social activities, and may influence family life. The goal of asthma therapy is to achieve asthma control, but only a limited number of patients are able to reach total control. This may be due to an incorrect diagnosis, co-morbidities or poor inhalation technique, but in the majority of cases non-adherence is the main reason for therapy failures. However, partnership with the parents and the child is important in order to set individually chosen goals of therapy and may be of help to improve control. Non-pharmacological measures aim at avoiding tobacco smoke, and when a child is sensitised, to avoid allergens. In pharmacological management international guidelines such as the GINA guideline and the British Guideline on the Management of Asthma are leading.

  6. Postpartum haemorrhage: prevention and treatment. (United States)

    Sentilhes, Loïc; Merlot, Benjamin; Madar, Hugo; Sztark, François; Brun, Stéphanie; Deneux-Tharaux, Catherine


    Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and severe maternal morbidity worldwide and strategies to prevent and treat PPH vary among international authorities. Areas covered: This review seeks to provide a global overview of PPH (incidence, causes, risk factors), prevention (active management of the third stage of labor and prohemostatic agents), treatment (first, second and third-line measures to control PPH), by also underlining recommendations elaborated by international authorities and using algorithms. Expert commentary: When available, oxytocin is considered the drug of first choice for both prevention and treatment of PPH, while peripartum hysterectomy remains the ultimate life-saving procedure if pharmacological and resuscitation measures fail. Nevertheless, the level of evidence for preventing and treating PPH is globally low. The emergency nature of PPH makes randomized controlled trials (RCT) logistically difficult. Population-based observational studies should be encouraged as they can usefully strengthen the evidence base, particularly for components of PPH treatment that are difficult or impossible to assess through RCT.

  7. Hodgkin Lymphoma: Diagnosis and Treatment. (United States)

    Ansell, Stephen M


    Hodgkin lymphoma is a rare B-cell malignant neoplasm affecting approximately 9000 new patients annually. This disease represents approximately 11% of all lymphomas seen in the United States and comprises 2 discrete disease entities--classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Within the subcategorization of classical Hodgkin lymphoma are defined subgroups: nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich Hodgkin lymphoma. Staging of this disease is essential for the choice of optimal therapy. Prognostic models to identify patients at high or low risk for recurrence have been developed, and these models, along with positron emission tomography, are used to provide optimal therapy. The initial treatment for patients with Hodgkin lymphoma is based on the histologic characteristics of the disease, the stage at presentation, and the presence or absence of prognostic factors associated with poor outcome. Patients with early-stage Hodgkin lymphoma commonly receive combined-modality therapies that include abbreviated courses of chemotherapy followed by involved-field radiation treatment. In contrast, patients with advanced-stage Hodgkin lymphoma commonly receive a more prolonged course of combination chemotherapy, with radiation therapy used only in selected cases. For patients with relapse or refractory disease, salvage chemotherapy followed by high-dose treatment and an autologous stem cell transplant is the standard of care. For patients who are ineligible for this therapy or those in whom high-dose therapy and autologous stem cell transplant have failed, treatment with brentuximab vedotin is a standard approach. Additional options include palliative chemotherapy, immune checkpoint inhibitors, nonmyeloablative allogeneic stem cell transplant, or participation in a clinical trial testing novel agents. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All

  8. Periodontal risk assessment, diagnosis and treatment planning. (United States)

    Pihlstrom, B L


    The prevention and treatment of the periodontal diseases is based on accurate diagnosis, reduction or elimination of causative agents, risk management and correction of the harmful effects of disease. Prominent and confirmed risk factors or risk predictors for periodontitis in adults include smoking, diabetes, race, P. gingivalis, P. intermedia, low education, infrequent dental attendance and genetic influences. Several other specific periodontal bacteria, herpesviruses, increased age, male, sex, depression, race, traumatic occlusion and female osteoporosis in the presence of heavy dental calculus have been shown to be associated with loss of periodontal support and can be considered to be risk indicators of periodontitis. The presence of furcation involvement, tooth mobility, and a parafunctional habit without the use of a biteguard are associated with a poorer periodontal prognosis following periodontal therapy. An accurate diagnosis can only be made by a thorough evaluation of data that have been systematically collected by: 1) patient interview, 2) medical consultation as indicated, 3) clinical periodontal examination, 4) radiographic examination, and 5) laboratory tests as needed. Clinical signs of periodontal disease such as pocket depth, loss of clinical attachment and bone loss are cumulative measures of past disease. They do not provide the dentist with a current assessment of disease activity. In an attempt to improve the ability to predict future disease progression, several types of diagnostic tests have been studied, including host inflammatory products and mediators, enzymes, tissue breakdown products and subgingival temperature. In general, the usefulness of these tests for predicting future disease activity remains to be established in terms of sensitivity, specificity and predictive value. Although microbiological analysis of subgingival plaque is not necessary to diagnose and treat most patients with periodontitis, it is helpful when treating

  9. Naegleria fowleri: pathogenesis, diagnosis, and treatment options. (United States)

    Grace, Eddie; Asbill, Scott; Virga, Kris


    Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America. Copyright © 2015, American Society for Microbiology. All Rights Reserved.


    Directory of Open Access Journals (Sweden)

    Winarta Lesmana Handrea


    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Undescended testis (UDT or cryptorchidism is one of the commonest abnormalities in male infants. In this anomaly, testes are not located normally in the scrotum. The incidence of UDT is 4-5% of term male infants, and 20-33% of premature male infants. The occurrence of abnormalities of hormones control or anatomy process that is required in the normal process of lowering the testes can cause UDT. UDT can be differentiated into palpable and nonpalpable. The diagnosis of UDT can be known through physical examination. However, if the testes are impalpable, laparoscopy can be done to determine the position of the testis. Hormonal therapy to overcome UDT is still under controversy. The action that often done is surgery, called orchidopexy. The most serious complication of orchidopexy is testicular atrophy. It occurs in a small percentage, which is about 5-10%. Infertility may occur in 1 to 3 of 4 adult males and the risk of occurrence of malignancies is increased by as much as 5-10 times higher in men with a history of UDT. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  11. Dealing with uncertainties: ethics of prenatal diagnosis and preimplantation genetic diagnosis to prevent mitochondrial disorders. (United States)

    Bredenoord, A L; Pennings, G; Smeets, H J; de Wert, G


    This paper aims to address the ethical issues regarding prenatal diagnosis and preimplantation genetic diagnosis (PGD) of mitochondrial disorders. Owing to the absence of effective treatment, the prevention of the transmission of mitochondrial disorders is considered to be of key importance. The characteristics of mtDNA, such as heteroplasmy and the genetic bottleneck, make it difficult to estimate recurrence risks correctly and to provide an accurate prognosis for many mtDNA mutations. A limited number of mtDNA mutations allow reliable predictions, though results in the 'grey zone' are problematic. Both prenatal diagnosis and PGD for mtDNA disorders are complicated by the interpretation of the test results. As a consequence, these applications confront both clinical practice and society at large with several ethical questions and issues for further debate, among which the acceptability of suboptimal genetic testing, the value and research use of embryos, the evaluation of late abortion, the ethics of PGD for disorders with an incomplete penetrance and variable expression, the possible transfer of embryos with residual health risks, the acceptability of risks and drawbacks of genetic reproductive technology in general, and the scope and limits of reproductive autonomy and professional responsibility.

  12. Diagnosis and treatment of obturator hernia

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Takamori; Kobayashi, Seiji; Shiraishi, Kou; Nishiumi, Takao; Mori, Syunji; Isobe, Kiyoshi; Furuta, Yoshiaki [Shizuoka Red Cross Hospital (Japan)


    Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

  13. Sepsis in Obstetrics: Treatment, Prognosis, and Prevention. (United States)

    Parfitt, Sheryl E; Bogat, Mary L; Roth, Cheryl

    Sepsis during pregnancy is one of the five leading causes of maternal mortality worldwide. Early recognition and prompt treatment of maternal sepsis is necessary to improve patient outcomes. Patient education on practices that reduce infections may be helpful in decreasing rates of sepsis. Education of nurses about early signs and symptoms of sepsis in pregnancy and use of obstetric-specific tools can assist in timely identification and better outcomes. Although the Surviving Sepsis Campaign (SSC) criteria for diagnosis of sepsis in the general population are not pertinent for obstetric patients, their treatment bundles (guidelines) are applicable and can be used to guide care of obstetric patients who develop sepsis.This article is the third in a series of three that discuss the importance of sepsis and septic shock in pregnancy. This article includes case studies, treatment, prognosis, education, and prevention of maternal sepsis.

  14. Nummular headache: diagnosis and treatment. (United States)

    Pareja, Juan A; Pareja, Julia


    Nummular headache (coin-shaped cephalgia) has an unusual distinct feature: it is characterized by mild-to-moderate pressure-like pain exclusively felt in a rounded or elliptical area typically 2-6 cm in diameter. Although any region of the head may be affected, the parietal area is the common localization of nummular headache. The pain remains confined to the same symptomatic area which does not change in shape or size with time. The pain is continuous but lancinating exacerbations lasting for several seconds or gradually increasing from 10 mins to 2 h may superimpose the baseline pain. The temporal pattern is either chronic or remitting. Pseudoremissions may be observed when the pain reaches a very low grade or only discomfort (not pain) in the affected area is reported. At times, discomfort may prevail. Either during symptomatic periods or interictally, the affected area may show a variable combination of hypoethesia, dysesthesia, paresthesia or tenderness. Physical and supplementary examinations are normal. Nummular headache emerges as a primary clear-cut clinical picture. The particular topography and signs of sensory dysfunction make it reasonable to vent the idea that nummular headache is an extracranial headache, probably stemming from epicranial tissues such as terminal branches of sensitive nerves. Nummular headache may seem to be the paradigm of epicranias (group of headaches and pericranial neuralgias stemming from epicranial tissues). Nummular headache must be distinguished from head pain secondary to local processes and from tender points of more extensive headaches. Although nummular headache may frequently coexist with other primary headaches, it has an independent course. Treatment is seldom necessary and in most cases simple reassurance is sufficient.

  15. [Cervical lymph node tuberculosis: diagnosis and treatment]. (United States)

    Zaatar, R; Biet, A; Smail, A; Strunski, V; Page, C


    The purpose of this study was to evaluate the advantages of surgery for diagnosis and treatment of cervical lymph node tuberculosis. This was a retrospective study from 1st January 1998 to 31st December 2007 including 30 patients with cervical lymph node tuberculosis. The population included 60% autochthones with a mean age of 47.1 years and a female predominance (73.33%). The lymph nodes were most often supraclavicular, unilateral, firm, and a mean 3 cm at its largest span. Lymph nodes were excised for diagnosis in 22 patients, which demonstrated specific granulomatous and giant cell lesions with caseous necrosis in 21 patients out of 22. Five abscessed adenopathies required surgical drainage, and three cases required repeated lymph node cleaning after well-conducted medical treatment. Surgery retains an important place in the diagnosis and treatment of cervical lymph node tuberculosis.

  16. Early breast cancer: diagnosis, treatment and survivorship.

    LENUS (Irish Health Repository)

    Meade, Elizabeth


    Breast cancer is the most common female cancer and globally remains a major public health concern. The diagnosis and treatment of breast cancer continues to develop. Diagnosis is now more precise, surgery is less mutilating and women now have the option of breast conserving therapy with better cosmesis, and without sacrificing survival. Radiotherapy is more targeted and the selection of patients for adjuvant chemotherapy is based not only on prognostic and predictive factors, but also on newer molecular profiling that will ensure that chemotherapy is given to the patients who need and respond to it. These developments all provide a more tailored approach to the treatment of breast cancer. Management now involves a multidisciplinary team approach in order to provide the highest standard of care for patients throughout their cancer journey from diagnosis through treatment and into follow-up care.

  17. Early and Periodic Screening, Diagnosis and Treatment (United States)

    U.S. Department of Health & Human Services — The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who...

  18. Nanotechnology in dentistry: prevention, diagnosis, and therapy. (United States)

    Abou Neel, Ensanya Ali; Bozec, Laurent; Perez, Roman A; Kim, Hae-Won; Knowles, Jonathan C


    Nanotechnology has rapidly expanded into all areas of science; it offers significant alternative ways to solve scientific and medical questions and problems. In dentistry, nanotechnology has been exploited in the development of restorative materials with some significant success. This review discusses nanointerfaces that could compromise the longevity of dental restorations, and how nanotechnolgy has been employed to modify them for providing long-term successful restorations. It also focuses on some challenging areas in dentistry, eg, oral biofilm and cancers, and how nanotechnology overcomes these challenges. The recent advances in nanodentistry and innovations in oral health-related diagnostic, preventive, and therapeutic methods required to maintain and obtain perfect oral health, have been discussed. The recent advances in nanotechnology could hold promise in bringing a paradigm shift in dental field. Although there are numerous complex therapies being developed to treat many diseases, their clinical use requires careful consideration of the expense of synthesis and implementation.

  19. Clinical diagnosis and treatment of olfactory meningioma

    International Nuclear Information System (INIS)

    Li Xiangdong; Wang Zhong; Zhang Shiming; Zhu Fengqing; Zhou Dai; Hui Guozhen


    Objective: To analyze the clinical diagnosis and treatment of olfactory meningioma. Methods: In this group 17 olfactory meningiomas were operated, and the clinical presentations and the surgery results were obtained. Results: The symptoms of psychiatrical disorder, visual disturbances and eclipse at presentation was higher. In 16 cases the grade of resection was Simpson II, 1 case Simpson III, most of the cases had a good recovery. Conclusion: Attention should be paid to the early symptom at presentation such as psychiatrical disorder to obtain an early diagnosis. Microsurgery is useful in the treatment of olfactory meningioma. (authors)

  20. Prevention and treatment of congenital toxoplasmosis

    DEFF Research Database (Denmark)

    Petersen, Eskild


    Infection with Toxoplasma gondii is transmitted to man by infected meat or meat products and by contact with soil or surface water. In theory, prevention by hygienic measures is possible, but this has never been proved to work in practice. Therefore, pre- and postnatal screening has been implemen......Infection with Toxoplasma gondii is transmitted to man by infected meat or meat products and by contact with soil or surface water. In theory, prevention by hygienic measures is possible, but this has never been proved to work in practice. Therefore, pre- and postnatal screening has been...... implemented in several countries aiming at early diagnosis. However, data on the effect of treatment are limited and no randomized, controlled trials have been performed. The risk of T. gondii infection in Europe is declining and studies using historical controls from earlier decades cannot be used...

  1. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. (United States)

    Meeusen, Romain; Duclos, Martine; Foster, Carl; Fry, Andrew; Gleeson, Michael; Nieman, David; Raglin, John; Rietjens, Gerard; Steinacker, Jürgen; Urhausen, Axel


    Successful training not only must involve overload but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short-term performance decrement without severe psychological or lasting other negative symptoms. This functional overreaching will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, nonfunctional overreaching (NFOR) can occur. The distinction between NFOR and overtraining syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal, and other signs and symptoms. A keyword in the recognition of OTS might be "prolonged maladaptation" not only of the athlete but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline, and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirm or refute this suggestion. One approach to understanding the etiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, and others together with identification of initiating events or triggers. In this article, we provide the recent status of possible markers for the detection of OTS. Currently, several markers (hormones, performance tests, psychological tests, and biochemical and immune markers) are used, but none of them meet all the criteria to make their use generally accepted.

  2. Preimplantation genetic diagnosis: its role in prevention of deafness. (United States)

    Taneja, M K


    Deafness is a global problem. In India deafness ranges from 4 % in urban to 11 % in rural and slum areas, out of which 50 % is conductive hearing loss hence curable. Genetic transmission accounts for 50 % of the cases of congenital deafness, and of these, around 30 % are syndromic and 70 % are non-syndromic. Genetic counseling is going to make aware the parents of all appropriate treatments. Preimplantation genetic diagnosis can help to have a baby free from genetic deafness. Procedure is almost safe, harmless, non-invasive and ethically acceptable. While Amniocentesis is a non-invasive method, prenatal genetic testing through Chorionic villous sampling is invasive. The connexin 26 (CX26W 24X) mutations are the most common cause of non-syndromic hearing loss and easy to identify by polymerase chain reaction. There is always co-morbidity after cochlear implantation and the person remains handicapped while baby after PGD shall be having healthy normal life and person prone to environmental factors may be counseled and guided to prevent deafness in next generation. Public must be made aware of noise pollution, tobacco toxicity and consanguinity. The Obstetrician and Pediatrician apart from ENT surgeon should be involved to prevent antenatal or neonatal deafness.

  3. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review

    NARCIS (Netherlands)

    Kuijper, B.; Tans, J. Th J.; Schimsheimer, R. J.; van der Kallen, B. F. W.; Beelen, A.; Nollet, F.; de Visser, M.


    Degenerative cervical radiculopathy: clinical diagnosis and conservative treatment. A review. To provide a state-of-the-art assessment of diagnosis and non-surgical treatment of degenerative cervical radiculopathy a literature search for studies on epidemiology, diagnosis including

  4. Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates). (United States)

    Almasio, Piero L; Babudieri, Sergio; Barbarini, Giorgio; Brunetto, Maurizia; Conte, Dario; Dentico, Pietro; Gaeta, Giovanni B; Leonardi, Claudio; Levrero, Massimo; Mazzotta, Francesco; Morrone, Aldo; Nosotti, Lorenzo; Prati, Daniele; Rapicetta, Maria; Sagnelli, Evangelista; Scotto, Gaetano; Starnini, Giulio


    The global spread of hepatitis B virus (HBV) and hepatitis C virus (HCV), their high chronicity rates and their progression to cirrhosis and hepatocellular carcinoma, are major public health problems. Research and intervention programmes for special population groups are needed in order to assess their infection risk and set up suitable prevention and control strategies. Aim of this paper is to give health care professionals information on HBV and HCV infections amongst migrants, drug users and prison inmates. The manuscript is an official Position Paper on behalf of the following Scientific Societies: Italian Association for the Study of the Liver (A.I.S.F.), Italian Society of Infectious and Tropical Diseases (S.I.M.I.T.), Italian Federation Department's Operators and Addiction Services (FederSerD), Italian Prison Medicine and Healthcare Society (S.I.M.S.Pe.). The considered population groups, having a high prevalence HBV and HCV infections, require specific interventions. In this context, the expression "special population" refers to specific vulnerable groups at risk of social exclusion, such as migrants, prison inmates, and intravenous drug users. When dealing with special population groups, social, environmental and clinical factors should be considered when selecting candidates for therapy as indicated by national and international guidelines. Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  5. Recommendations for diagnosis and treatment of spondylodiscitis. (United States)

    Fransen, B L; de Visser, E; Lenting, A; Rodenburg, G; van Zwet, A A; Gisolf, E H


    Spondylodiscitis, also known as vertebral osteomyelitis, is a destructive disease with high morbidity and mortality. Diagnosis is often delayed because of the rarity of the disease and the fact that early symptoms are often non-specific. There are currently no national guidelines on the diagnosis and treatment of spondylodiscitis in the Netherlands. We performed a single-centre retrospective cohort study examining 49 patients over 18 years of age treated for spondylodiscitis in a six-year time period. Mean age of patients was 69 years (range 40-89). Most patients underwent an MRI scan to confirm diagnosis (n=30). In 39 patients a microorganism was found, most commonly Staphylococcus aureus (n=14), Streptococcus species (n=11) and Gram-negative bacteria (n=11). All patients were treated with antibiotics. Thirty-seven patients received antibiotic treatment for at least six weeks, while 17 patients were treated for 90 days or longer. In 13 patients no adequate treatment was started until culture results were available. Eleven patients underwent surgery after their diagnosis. Two patients had a recurrence. We recommend that, when considering spondylodiscitis as a possible diagnosis, all patients should undergo thorough physical examination, neurological screening, blood tests for infection and blood cultures. An MRI scan should be performed, followed by a PET-CT scan when results are inconclusive. Ideally a CT-guided biopsy is performed before treatment is started. Awaiting culture results all patients should receive broad-spectrum antibiotics. Targeting only Gram-positive microorganisms in empiric treatment will lead to a delay in adequate treatment in a substantial group of patients. A multidisciplinary approach is advocated.

  6. Diagnosis and treatment of polonium poisoning. (United States)

    Jefferson, Robert D; Goans, Ronald E; Blain, Peter G; Thomas, Simon H L


    Interest in the clinical toxicology of (210)polonium ((210)Po) has been stimulated by the poisoning of Alexander Litvinenko in 2006. This article reviews the clinical features, diagnosis, and treatment of acute radiation syndrome (ARS) resulting from the ingestion of (210)Po. PHYSICAL CHARACTERISTICS: (210)Po is a high-energy alpha-emitter (radioactive half-life 138 days) that presents a radiation hazard only if taken into the body, for example, by ingestion, because of the low range of alpha particles in biological tissues. As a result, external contamination does not cause radiation sickness. Ingested (210)Po is concentrated initially in red blood cells and then the liver, kidneys, spleen, bone marrow, gastrointestinal (GI) tract, and gonads. (210)Po is excreted in urine, bile, sweat, and (possibly) breath and is also deposited in hair. After ingestion, unabsorbed (210)Po is present in the faeces. The elimination half-life in man is approximately 30-50 days. In the absence of medical treatment, the fatal oral amount is probably in the order of 10-30 microg. If the absorbed dose is sufficiently large (e.g., >0.7 Gy), (210)Po can cause ARS. This is characterized by a prodromal phase, in which nausea, vomiting, anorexia, lymphopenia, and sometimes diarrhea develop after exposure. Higher radiation doses cause a more rapid onset of symptoms and a more rapid reduction in lymphocyte count. The prodromal phase may be followed by a latent phase during which there is some clinical improvement. Subsequently, the characteristic bone marrow (0.7-10 Gy), GI (8-10 Gy), or cardiovascular/central nervous system syndromes (>20 Gy) develop, with the timing and pattern of features dependent on the systemic dose. The triad of early emesis followed by hair loss and bone marrow failure is typical of ARS. Those patients who do not recover die within weeks to months, whereas in those who survive, full recovery can take many months. Serial blood counts are important for assessing the rate

  7. Chronic fatigue syndrome: aetiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Palacín Delgado Cecilia


    Full Text Available Abstract Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress, although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.

  8. Giant cell arteritis: diagnosis and treatment. (United States)

    Calvo Romero, J M


    Giant cell arteritis is the most common primary systemic vasculitis in adults. The condition is granulomatous arteritis of large and medium vessels, which occurs almost exclusively in patients aged 50 years or more. This article reviews the diagnosis and treatment of the disease. Copyright © 2015. Published by Elsevier España, S.L.U.

  9. Diagnosis and treatment of upper limb apraxia. (United States)

    Dovern, A; Fink, G R; Weiss, P H


    Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients' everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients' prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed and ill-treated entity. Based on a systematic literature search, this review summarizes the current tools of diagnosis and treatment strategies for upper limb apraxia. It furthermore provides clinicians with graded recommendations. In particular, a short screening test for apraxia, and a more comprehensive diagnostic apraxia test for clinical use are recommended. Although currently only a few randomized controlled studies investigate the efficacy of different apraxia treatments, the gesture training suggested by Smania and colleagues can be recommended for the therapy of apraxia, the effects of which were shown to extend to activities of daily living and to persist for at least 2 months after completion of the training. This review aims at directing the reader's attention to the ecological relevance of apraxia. Moreover, it provides clinicians with appropriate tools for the reliable diagnosis and effective treatment of apraxia. Nevertheless, this review also highlights the need for further research into how to improve diagnosis of apraxia based on neuropsychological models and to develop new therapeutic strategies.

  10. Cervicogenic vertigo: etiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Elham Tavanai


    Full Text Available Background and Aim: Cervicogenic dizziness is induced by a specific neck position and the earth’s gravity has no effect on provoking of it. The precise incidence of cervicogenic dizziness is not certain but, 20-58% of patients following sudden head injuries experience its symptoms . In this article, the etiology, diagnosis and treatment of cervicogenic vertigo is discussed. Methods: At first, articles of cervicogenic dizziness from electronic databases of Google scholar , PubMed, Scopus, Ovid and CINAHL were searched from 1987 up to 2012. Then, the articles in them vertigo, disequilibrium or nystagmus were consistent with neck disorders were searched. Conclusion: Articles with title of cervicogenic vertigo (cervical vertigo were limited. Clinical researches about cervicogenic vertigo up to now implicate on several points; all signify that we cannot diagnose it certainly and there is not any specific single test for that. Recently, smooth pursuit neck torsion test (SPNTT has introduced for diagnosis of cervicogenic vertigo that is not valid yet. There is no protocol for diagnosis of cervicogenic vertigo and diagnosis is often based on limited clinical experiences of clinicians. Physiotherapy, medication and manual therapies are options for treatment but there is no distinct and effective treatment for it and in just one article, a combination of treatments for cervicogenic vertigo as a protocol has recommended.

  11. Diagnosis and treatment of Helicobacter pylori infection

    DEFF Research Database (Denmark)

    Bytzer, Peter; Dahlerup, Jens Frederik; Eriksen, Jens Ravn


    National Danish guidelines for the diagnosis and treatment of Helicobacter pylori (Hp) infection have been approved by the Danish Society for Gastroenterology. All patients with peptic ulcer disease, gastric cancer, and MALT lymphoma should be tested for Hp. We also recommend testing in first...


    Directory of Open Access Journals (Sweden)

    T. V. Korotaeva


    Full Text Available The lecture gives basic information about psoriatic arthritis (PsA, a chronic inflammatory disease of the joints, spine, and enthesises from a group of spondyloarthritis. It describes the epidemiology of the disease and considers current ideas on its pathogenesis and factors influencing the development of PsA in psoriatic patients. The classification and clinical forms of PsA are presented. The major clinical manifestations of the disease are indicated to include peripheral arthritis, enthesitis, dactylitis, and spondylitis. The diagnosis of the disease is noted to be established on the basis of its detected typical clinical and radiological signs, by applying the CASPAR criteria. A dermatologist, rheumatologist, and general practitioner screen PsA, by actively detecting complaints, characteristic clinical and radiological signs of damage to the joints, and/or spine, and/or enthesises and by using screening questionnaires. There are data that patients with PsA are observed to be at higher risk for a number of diseases type 2 diabetes mellitus hypertension, coronary heart disease, obesity, metabolic syndrome, inflammatory bowel diseases, etc. The aim of current pharmacotherapy for PsA is to achieve remission or minimal activity of clinical manifestations of the disease, to delay or prevent its X-ray progression, to increase survival, to improve quality of life in patients, and to reduce the risk of comorbidities. The paper considers groups of medicines used to treat the disease, among other issues, information about biological agents (BA registered in the Russian Federation for the treatment of PsA. Most patients are mentioned to show a good response to this therapy option just 3–6 months after treatment initiation; however, some of them develop primary inefficiency. In this case, switching one BA to another is recommended. Some patients using a BA develop secondary treatment inefficiency, which is firstly due to the appearance of

  13. Cancer Nanotechnology: Opportunities for Prevention, Diagnosis, and Therapy. (United States)

    Zeineldin, Reema; Syoufjy, Joan


    Nanotechnological innovations over the last 16 years have brought about the potential to revolutionize specific therapeutic drug delivery to cancer tissue without affecting normal tissues. In addition, there are new nanotechnology-based platforms for diagnosis of cancers and for theranostics, i.e., integrating diagnosis with therapy and follow-up of effectiveness of therapy. This chapter presents an overview of these nanotechnology-based advancements in the areas of prevention, diagnosis, therapy, and theranostics for cancer. In addition, we stress the need to educate bio- and medical students in the field of nanotechnology.

  14. Diagnosis and treatment of DVT and prevention of DVT recurrence and the PTS: bridging the gap between DVT and PTS in the primary care setting or outpatient ward

    Directory of Open Access Journals (Sweden)

    Michiels JJ


    Full Text Available Jan Jacques Michiels,1–3 Wim Moosdorff,1 Mildred U Lao,1 Hanny Maasland,1 Janneke Maria Michiels,2,4 HA Martino Neumann,5 Petr Dulicek,6 Viera Stvrtinova,3,7 Pavel Poredos,3,8 Jacques Barth,1,3 Gualtiero Palareti,3,9 1Primary Care Medicine Medical Diagnostic Center, Rotterdam, 2Goodheart Institute, Blood Coagulation and Vascular Medicine Science Center, Rotterdam, the Netherlands; 3Central European Vascular Forum, Prague, Czech Republic; 4Primary Care Medicine, Leiden University Medical Center, Leiden, 5Department of Dermatology, Section Phlebology, Erasmus University Medical Center, Rotterdam, the Netherlands; 64th Department of Internal Medicine – Hematology, University Hospital in Hradec Kralove and Charles University in Prague, Faculty of Medicine, Hradec Králové, Czech Republic; 7Internal Medicine Medical Faculty, Comenius University, Bratislava, Slovakia; 8University Medical Centre Ljubljana, Department of Vascular Disease, Ljubljana, Slovenia; 9Department of Angiology and Blood Coagulation, University Hospital, Bologna, Italy Abstract: Duplex ultrasonography (DUS does pick up alternative diagnoses (AD including Baker's cyst, muscle hematomas, old deep vein thrombosis (DVT, and superficial vein thrombosis. The sequential use of DUS followed by a sensitive D-dimer test and a clinical score assessment is a safe and effective noninvasive strategy to exclude and diagnose DVT and AD in patients with suspected DVT. DVT patients are recommended to wear medical elastic stockings (MECS for symptomatic relief of swollen legs during the acute phase of DVT, or when postthrombotic syndrome (PTS is present. In routine daily practice, discontinuation of anticoagulation at 6 months post-DVT is followed by a subsequent 20%–30% DVT recurrence rate; this is the main cause of PTS after 1–5 years of follow-up. To bridge the gap between DVT and PTS, the frequent occurrence of PTS is best prevented by prolonged anticoagulation, if indicated, based on

  15. Diagnosis and treatment of Lyme arthritis. (United States)

    Arvikar, Sheila L; Steere, Allen C


    In the United States, Lyme arthritis is the most common feature of late-stage Borrelia burgdorferi infection, usually beginning months after the initial bite. In some, earlier phases are asymptomatic and arthritis is the presenting manifestation. Patients with Lyme arthritis have intermittent or persistent attacks of joint swelling and pain in 1 or a few large joints. Serologic testing is the mainstay of diagnosis. Synovial fluid polymerase chain reaction for B burgdorferi DNA is often positive before treatment, but is not a reliable marker of spirochetal eradication after therapy. This article reviews the clinical manifestations, diagnosis, and management of Lyme arthritis. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Enrico Bellato


    Full Text Available Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud’s phenomenon, irritable bowel disease, and heat and cold intolerance can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2, milnacipran (NNT 19, and pregabalin (NNT 8.6 are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy.

  17. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment (United States)

    Bellato, Enrico; Marini, Eleonora; Castoldi, Filippo; Barbasetti, Nicola; Mattei, Lorenzo; Bonasia, Davide Edoardo; Blonna, Davide


    Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy. PMID:23213512

  18. Wolfram Syndrome: Diagnosis, Management, and Treatment. (United States)

    Urano, Fumihiko


    Wolfram syndrome is a rare genetic disorder characterized by juvenile-onset diabetes mellitus, diabetes insipidus, optic nerve atrophy, hearing loss, and neurodegeneration. Although there are currently no effective treatments that can delay or reverse the progression of Wolfram syndrome, the use of careful clinical monitoring and supportive care can help relieve the suffering of patients and improve their quality of life. The prognosis of this syndrome is currently poor, and many patients die prematurely with severe neurological disabilities, raising the urgency for developing novel treatments for Wolfram syndrome. In this article, we describe natural history and etiology, provide recommendations for diagnosis and clinical management, and introduce new treatments for Wolfram syndrome.

  19. Does Diagnosis of Hypertension Prevent Stroke? A Preliminary ...

    African Journals Online (AJOL)

    Introduction: The present study was designed to determine the relative frequency of previously diagnosed and undiagnosed hypertension in first stroke in order to evaluate if previous diagnosis of hypertension can prevent stroke. Patients and Methods: One hundred and twenty nine first stroke patients presenting at the ...

  20. Tuberculous meningitis: advances in diagnosis and treatment. (United States)

    Török, M E


    Tuberculous meningitis (TBM) is the most severe form of infection caused by Mycobacterium tuberculosis, causing death or disability in more than half of those affected. The aim of this review is to examine recent advances in our understanding of TBM, focussing on the diagnosis and treatment of this devastating condition. Papers on TBM published between 1891 and 2014 and indexed in the NCBI Pubmed. The following search terms were used: TBM, diagnosis, treatment and outcome. The diagnosis of TBM remains difficult as its presentation is non-specific and may mimic other causes of chronic meningoencephalitis. Rapid recognition of TBM is crucial, however, as delays in initiating treatment are associated with poor outcome. The laboratory diagnosis of TBM is hampered by the low sensitivity of cerebrospinal fluid microscopy and the slow growth of M. tuberculosis in conventional culture systems. The current therapy of TBM is based on the treatment of pulmonary tuberculosis, which may not be ideal. The combination of TBM and HIV infection poses additional management challenges because of the need to treat both infections and the complications associated with them. The pathogenesis of TBM remains incompletely understood limiting the development of interventions to improve outcome. The optimal therapy of TBM has not been established in clinical trials, and increasing antimicrobial resistance threatens successful treatment of this condition. The use of adjunctive anti-inflammatory agents remains controversial, and their mechanism of action remains incompletely understood. The role of surgical intervention is uncertain and may not be available in areas where TBM is common. Laboratory methods to improve the rapid diagnosis of TBM are urgently required. Clinical trials of examining the use of high-dose rifampicin and/or fluoroquinolones are likely to report in the near future. The use of biomarkers to improve the rapid diagnosis of TBM warrants further investigation. The role of

  1. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria


    Full Text Available Introduction Laryngopharyngeal reflux (LPR is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

  2. Lumbar pseudarthrosis: a review of current diagnosis and treatment. (United States)

    Chun, Danielle S; Baker, Kevin C; Hsu, Wellington K


    OBJECT Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed. METHODS A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I-III; 3) diagnosis of degenerative lumbar spine conditions and/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration. RESULTS Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation. CONCLUSIONS Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis.

  3. [Revised guideline 'Diabetic retinopathy: screening, diagnosis and treatment'

    NARCIS (Netherlands)

    Polak, B.C.P.; Hartstra, W.W.; Ringens, P.J.; Scholten, R.J.


    The revised evidence-based guideline 'Diabetic retinopathy: screening, diagnosis and treatment' contains important recommendations concerning screening, diagnosis and treatment of diabetic retinopathy. Regular screening and the treatment of risk factors, such as hyperglycemia, hypertension,

  4. Diagnosis of onychomycosis by trypsin treatment method

    Directory of Open Access Journals (Sweden)

    Xess Immaculata


    Full Text Available Background: Fungal infection of the nails is a common, difficult to treat problem, prevalent worldwide. A discrepancy in the microscopic examination and culture findings can create problems in the diagnosis of this common infection. Aim: This study was designed to evaluate a new method for accurate diagnosis of onychomycosis. Materials and Methods: Nail samples from 25 patients of suspected onychomycosis were taken. A portion of the samples was treated with 2% trypsin before culturing and the rest was processed by the standard mycological technique. Results: A higher number of culture positive samples were obtained by the trypsin treatment method as compared to the standard technique. Conclusion: Trypsin treatment prior to culture increases the isolation of fungi from nail samples.

  5. Hepatorenal syndrome: diagnosis, treatment and prevention

    DEFF Research Database (Denmark)

    Israelsen, Mads Egerod; Gluud, Lise Lotte; Bendtsen, Flemming


    Cirrhosis, ascites and renal impairment are associated with high morbidity and mortality. The hepatorenal syndrome (HRS) is a type of renal failure that affects patients with cirrhosis and ascites. This paper provides an update on evidence-based interventions in HRS. A number of factors can...

  6. Diagnosis, Treatment, and Prevention of Malaria (United States)


    organisms from the gut, through an intestinal wall subjected to the stress of microcirculatory obstruction by para - sitized erythrocytes, is a recent review the authors concluded that it was not necessary (M. Wolfe, personal communication, 1992). Chloroquine may exacerbate psoriasis

  7. Diagnosis and treatment of upper limb apraxia


    Dovern, A.; Fink, G. R.; Weiss, P. H.


    Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients’ everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients’ prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed...

  8. Cervicogenic headache: Differential diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Aleksey Nikolayevich Barinov


    Full Text Available The paper discusses the issues of differential diagnosis of cervicocranialgia with tension headache and migraine with concomitant cervical myofascial syndrome. It considers the basic mechanisms of the pathogenesis of these nosological entities and common approaches to their treatment. The mechanisms of pathogenetic action of myorelaxants are shown in cervicocranialgia and myofascial pain syndromes. Methods for mini-invasive therapy for cervicogenic headache and other musculoskeletal disorders are presented.

  9. Diagnosis and treatment of the cracked tooth. (United States)

    Fox, K; Youngson, C C


    This review paper discusses the recognised factors which predispose to cracked-tooth syndrome. In addition, common presenting symptoms and the various methods to aid clinical diagnosis of this problem are examined. The incidence of the condition is reported and the prognosis of the various forms of fracture, as suggested by clinical presentation, are outlined with reference to the available literature. Benefits and relative demerits of traditional and more modern treatment options are presented and recommendations made for future research.

  10. Diagnosis and Treatment of Pityriasis Rubra Pilaris

    Directory of Open Access Journals (Sweden)

    Kubanov Alexey


    Full Text Available The article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP. The authors analyze the diagnostic errors, present literature review, and their own observations. The clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2% patients, 6 (26% patients received treatment for toxic exanthema, and only 2 (8.8% patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months.

  11. Diagnosis and treatment of Helicobacter pylori infection

    DEFF Research Database (Denmark)

    Bytzer, Peter; Dahlerup, Jens Frederik; Eriksen, Jens Ravn


    National Danish guidelines for the diagnosis and treatment of Helicobacter pylori (Hp) infection have been approved by the Danish Society for Gastroenterology. All patients with peptic ulcer disease, gastric cancer, and MALT lymphoma should be tested for Hp. We also recommend testing in first...... with a rapid urease test. Proton pump inhibitor therapy should be stopped at least 1 week prior to Hp testing. All infected patients should be offered Hp eradication therapy. First-line treatment is 7-day triple therapy with a proton pump inhibitor and clarithromycine in combination with metronidazole...

  12. Diagnosis and treatment of radiation injuries

    International Nuclear Information System (INIS)

    Dalci, D.; Doerter, G.; Gueclue, I.


    This publication is the translation of IAEA Safety Reports Series No.2 ,Diagnosis and Treatment of Radiation Injuries. This report is directed at medical professionals who may be involved in the management of radiation injuries starting from the first few hours or days after an exposure of undefined severity. The principal aim of this publication is to provide guidelines to enable medical professionals to carry out prompt diagnostic measure and to offer emergency treatment. This report provides information in tabulated form on clinical criteria for dose assesment. Additionally, it discusses the appropriate dose-effect relationship in cases of external radiation involving either total body or local exposures, as well as internal contamination

  13. Prevention and Treatment of Drowning. (United States)

    Mott, Timothy F; Latimer, Kelly M


    Nearly 4,000 drowning deaths occur annually in the United States, with drowning representing the most common injury-related cause of death in children one to four years of age. Drowning is a process that runs the spectrum from brief entry of liquid into the airways with subsequent clearance and only minor temporary injury, to the prolonged presence of fluid in the lungs leading to lung dysfunction, hypoxia, neurologic and cardiac abnormalities, and death. The World Health Organization has defined drowning as "the process of experiencing respiratory impairment from submersion/immersion in liquid." Terms such as near, wet, dry, passive, active, secondary, and silent drowning should no longer be used because they are confusing and hinder proper categorization and management. The American Heart Association's Revised Utstein Drowning Form and treatment guidelines are important in guiding care, disposition, and prognosis. Prompt resuscitation at the scene after a shorter duration of submersion is associated with better outcomes. Because cardiac arrhythmias due to drowning are almost exclusively caused by hypoxia, the resuscitation order prioritizes airway and breathing before compressions. Prevention remains the best treatment. Education, swimming and water safety lessons, and proper pool fencing are the interventions with the highest level of current evidence, especially in children two to four years of age. Alcohol use during water activities dramatically increases the risk of drowning; therefore, abstinence is recommended for all participants and supervisors.

  14. Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Ibrahim A. Abdel-Hamid


    Full Text Available Delayed ejaculation (DE is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. It is often quite concerning to patients and their partners, and sometimes frustrates couples’ attempts to conceive. This article aims to review the pathophysiology of DE and anejaculation (AE, to explore our current understanding of the diagnosis, and to present the treatment options for this condition. Electronic databases were searched from 1966 to October 2017, including PubMed (MEDLINE and Embase. We combined “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” or “anejaculation” as Medical Subject Headings (MeSH terms or keywords with “epidemiology,” “etiology,” “pathophysiology,” “clinical assessment,” “diagnosis,” or “treatment.” Relevant sexual medicine textbooks were searched as well. The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. An approved form of drug therapy does not exist. A number of approaches can be employed for infertile men, including the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, sperm retrieval by aspiration from either the vas deferens or the epididymis, and testicular sperm extraction.

  15. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud


    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  16. The diagnosis and treatment of dermatitis herpetiformis

    Directory of Open Access Journals (Sweden)

    Antiga E


    Full Text Available Emiliano Antiga, Marzia Caproni Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy Abstract: Dermatitis herpetiformis (DH is an inflammatory cutaneous disease with a chronic relapsing course, pruritic polymorphic lesions, and typical histopathological and immunopathological findings. According to several evidences, DH is considered the specific cutaneous manifestation of celiac disease, and the most recent guidelines of celiac disease have stated that, in celiac patients with a proven DH, a duodenal biopsy is unnecessary for the diagnosis. In this review, the most recent data about the diagnosis and the management of DH have been reported and discussed. In particular, in patients with clinical and/or histopathological findings suggestive for DH, the finding of granular IgA deposits along the dermal–epidermal junction or at the papillary tips by direct immunofluorescence (DIF assay, together with positive results for anti-tissue transglutaminase antibody testing, allows the diagnosis. Thereafter, a gluten-free diet should be started in association with drugs, such as dapsone, that are able to control the skin manifestations during the first phases of the diet. In conclusion, although DH is a rare autoimmune disease with specific immunopathological alterations at the skin level, its importance goes beyond the skin itself and may have a big impact on the general health status and the quality of life of the patients. Keywords: dermatitis herpetiformis, celiac disease, diagnosis, treatment, autoimmune disease, inflammatory cutaneous disease 

  17. Diagnosis and treatment of traumatic pancreatic injury

    International Nuclear Information System (INIS)

    Hirakawa, Akihiko; Isayama, Kenji; Nakatani, Toshio


    The diagnosis of traumatic pancreatic injury in the acute stage is difficult to establish blood tests and abdominal findings alone. Moreover, to determine treatment strategies, it is important not only that a pancreatic injury is diagnosed but also whether a pancreatic ductal injury can be found. At our center, to diagnose isolated pancreatic injuries, we actively perform endoscopic retrograde pancreatography (ERP) in addition to abdominal CT at the time of admission. For cases with complications such as abdominal and other organ injuries, we perform a laparotomy to ascertain whether a pancreatic duct injury is present. In regard to treatment options, for grade III injuries to the pancreatic body and tail, we basically choose distal pancreatectomy, but we also consider the Bracy method depending on the case. As for grade III injuries to the pancreatic head, we primarily choose pancreaticoduodenectomy, but also apply drainage if the situation calls for it. However, pancreatic injuries are often complicated by injuries of other regions of the body. Thus, diagnosis and treatment of pancreatic injury should be based on a comprehensive decision regarding early prioritization of treatment, taking hemodynamics into consideration after admission, and how to minimize complications such as anastomotic leak and pancreatic fistulas. (author)

  18. Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention. (United States)

    van Zuylen, Wendy J; Hamilton, Stuart T; Naing, Zin; Hall, Beverly; Shand, Antonia; Rawlinson, William D


    Cytomegalovirus is the most common congenital infection causing serious disease in infants. It is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disability in developed countries. Despite the clinical importance of congenital cytomegalovirus, surveys show there is limited awareness and knowledge in the medical and general community about congenital cytomegalovirus infection. This article reviews the clinical features, global epidemiology, transmission and risk factors for cytomegalovirus infections. It also highlights several major advances made in recent years in the diagnosis and prevention of cytomegalovirus infection during pregnancy. Although research is ongoing, no therapy is currently proven to prevent or treat maternal, fetal or neonatal cytomegalovirus infection. Education of women regarding hygiene measures can help prevent cytomegalovirus infection and are currently the best strategy to prevent congenital cytomegalovirus disease.

  19. Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention (United States)

    van Zuylen, Wendy J; Hamilton, Stuart T; Naing, Zin; Hall, Beverly; Shand, Antonia


    Cytomegalovirus is the most common congenital infection causing serious disease in infants. It is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disability in developed countries. Despite the clinical importance of congenital cytomegalovirus, surveys show there is limited awareness and knowledge in the medical and general community about congenital cytomegalovirus infection. This article reviews the clinical features, global epidemiology, transmission and risk factors for cytomegalovirus infections. It also highlights several major advances made in recent years in the diagnosis and prevention of cytomegalovirus infection during pregnancy. Although research is ongoing, no therapy is currently proven to prevent or treat maternal, fetal or neonatal cytomegalovirus infection. Education of women regarding hygiene measures can help prevent cytomegalovirus infection and are currently the best strategy to prevent congenital cytomegalovirus disease. PMID:27512442

  20. Psychological effects of diagnosis and treatment of cervical intraepithelial neoplasia

    DEFF Research Database (Denmark)

    Frederiksen, Maria Eiholm; Njor, Sisse; Lynge, Elsebeth


    statistical testing, we estimated the statistical significance of the differences between the compared groups using unpaired t tests. MAIN RESULTS: From 5099 retrieved abstracts, 16 studies were included. Diagnosis and treatment of CIN were associated with worse psychological outcomes than normal cytology...... test results, but the impact decreased over time. In several but not all studies, CIN appeared to have similar psychological consequences to abnormal smears. No study showed a difference in psychological outcomes between CIN and cervical cancer diagnosis when these were measured some years after......BACKGROUND: Treatment of cervical intraepithelial neoplasia (CIN) is a common minor surgical procedure to prevent uterine cervical cancer. However, news of an abnormality detected at screening for cancer might cause the woman to worry. OBJECTIVES: To investigate the psychological consequences...

  1. Aetiology, Diagnosis and Treatment of Ankyloglossia

    Directory of Open Access Journals (Sweden)

    Charisi Christina


    Full Text Available This review paper occupies with the frequency, etiology, diagnosis, treatment and the possible complications of Ankyloglossia (AG. AG is a congenital anomaly and its range varies from 0,1% to 4,8 %. There are several methods for the diagnosis of AG. The most popular method is the ‘’Hazelbaker’’, which assesses seven different tongue movements and five appearance characteristics. As far as the management of AG is concerned, there are two options, the ‘’wait-and-see’’ and the invasive procedure. The operator can choose between the frenotomy and the frenectomy. The difference is that in frenectomy the clinician removes the whole frenulum. Few complications have been mentioned, such as ulcers, pain, bleeding and noticeable scar, which were brought on to a second operation.

  2. Hepatorenal Syndrome: Aetiology, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    G. Low


    Full Text Available Acute renal impairment is common in patients with chronic liver disease, occurring in approximately 19% of hospitalised patients with cirrhosis. A variety of types of renal impairment are recognised. The most important of these is the hepatorenal syndrome, a functional renal impairment due to circulatory and neurohormonal abnormalities that underpin cirrhosis. It is one of the most severe complications of cirrhosis with survival often measured in weeks to months. A variety of treatment options exist with early diagnosis and appropriate treatment providing the best hope for cure. This paper provides a comprehensive and up-to-date review of hepatorenal syndrome and lays out the topic according to the following sections: pathophysiology, historical developments, diagnostic criteria and limitations, epidemiology, precipitating factors, predictors, clinical and laboratory findings, prognosis, treatment options, prophylaxis, and conclusion.

  3. Diagnosis and treatment with endoscopic retrograde cholangiopancreatography

    International Nuclear Information System (INIS)

    Soendenaa, K.; Horn, A.; Viste, A.


    Endoscopic retrograde cholangiopancreatography (ERCP) was carried out for the first time in 1968. Five years later endoscopic sphincterotomy was performed. Since then both modalities have become established as necessary adjuncts in the diagnosis and treatment of patients with pathology in the bile duct or pancreas. The main indication is common bile duct stone, and as a consequence of this treatment fewer patients are now treated surgically. Patients with malignant bile duct obstruction can be given reasonable palliation of both jaundice and pruritus and therefore improved quality of life. Some reports indicate that endoscopic drainage may be useful for pancreatic stenosis. Complications are few, but vigilance and prompt treatment is necessary to keep morbidity at a minimum. Follow-up after several years shows that sphincterotomy is successful also in the long term. The authors discuss the present diagnostic and therapeutic situation. 31 refs., 2 tabs

  4. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. (United States)

    Woods, Barrett I; Hilibrand, Alan S


    Cervical radiculopathy is a relatively common neurological disorder resulting from nerve root dysfunction, which is often due to mechanical compression; however, inflammatory cytokines released from damaged intervertebral disks can also result in symptoms. Cervical radiculopathy can often be diagnosed with a thorough history and physical examination, but an magnetic resonance imaging or computed tomographic myelogram should be used to confirm the diagnosis. Because of the ubiquity of degenerative changes found on these imaging modalities, the patient's symptoms must correlate with pathology for a successful diagnosis. In the absence of myelopathy or significant muscle weakness all patients should be treated conservatively for at least 6 weeks. Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections. Cervical radiculopathy typically is self-limiting with 75%-90% of patients achieving symptomatic improvement with nonoperative care. For patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficit surgical treatment is appropriate. Surgical options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy. Patient selection is critical to optimize outcome.

  5. Hyponatraemia diagnosis and treatment clinical practice guidelines. (United States)

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; van Biesen, Wim; Nagler, Evi; Gonzalez-Espinoza, Liliana; Ortiz, Alberto

    Hyponatremia, defined as a serum sodium concentration <135mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay. Despite this, the management of hyponatremia patients remains problematic. The prevalence of hyponatremia in a wide variety of conditions and the fact that hyponatremia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and specialty-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed clinical practice guidelines on the diagnostic approach and treatment of hyponatremia as a joint venture of 3societies representing specialists with a natural interest in hyponatremia. In addition to a rigorous approach to the methodology and evaluation of the evidence, the document focuses on patient-positive outcomes and on providing a useful tool for clinicians involved in everyday practice. In this article, we present an abridged version of the recommendations and suggestions for the diagnosis and treatment of hyponatremia extracted from the full guide. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Diagnosis and treatment of malignant pleural mesothelioma. (United States)

    Rodríguez Panadero, Francisco


    There are three major challenges in the diagnosis of malignant pleural mesothelioma: mesothelioma must be distinguished from benign mesothelial hyperplasia; malignant mesothelioma (and its subtypes) must be distinguished from metastatic carcinoma; and invasion of structures adjacent to the pleura must be demonstrated. The basis for clarifying the first two aspects is determination of a panel of monoclonal antibodies with appropriate immunohistochemical evaluation performed by highly qualified experts. Clarification of the third aspect requires sufficiently abundant, deep biopsy material, for which thoracoscopy is the technique of choice. Video-assisted needle biopsy with real-time imaging can be of great assistance when there is diffuse nodal thickening and scant or absent effusion. Given the difficulties of reaching an early diagnosis, cure is not generally achieved with radical surgery (pleuropneumonectomy), so liberation of the tumor mass with pleurectomy/decortication combined with chemo- or radiation therapy (multimodal treatment) has been gaining followers in recent years. In cases in which surgery is not feasible, chemotherapy (a combination of pemetrexed and platinum-derived compounds, in most cases) with pleurodesis or a tunneled pleural drainage catheter, if control of pleural effusion is required, can be considered. Radiation therapy is reserved for treatment of pain associated with infiltration of the chest wall or any other neighboring structure. In any case, comprehensive support treatment for pain control in specialist units is essential: this acquires particular significance in this type of malignancy. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  7. [Differential diagnosis and treatment of cramps]. (United States)

    Diener, H C; Westphal, K


    Cramps are painful sensations caused by intense involuntary contractions of skeletal muscles, mostly in the calves, usually lasting from a few seconds to several minutes. Although cramps are mostly idiopathic, theycan bea symptom of other forms of myalgia, restless legs syndrome or spasticity. Especially nocturnal cramps can cause considerable distress for patients requiring fast pain reduction and effective prophylaxis. Stretching the calf muscles helps preventing nocturnal cramps. Pharmacological treatment of leg cramps includes magnesium and quinine.

  8. Headaches and Migraines: Headache Symptoms, Diagnosis, and Treatment (United States)

    ... Issue Past Issues Headaches and Migraines Headache Symptoms, Diagnosis, and Treatment Past Issues / Spring 2009 Table of Contents For ... types of headache. Each has distinct symptoms and treatments. Migraine ... and Diagnosis Migraine: The most common of vascular headaches, migraines ...

  9. Diagnosis and treatment of osteochondritis dissecans. (United States)

    Chambers, Henry G; Shea, Kevin G; Anderson, Allen F; Brunelle, Tommy J Jojo; Carey, James L; Ganley, Theodore J; Paterno, Mark V; Weiss, Jennifer M; Sanders, James O; Watters, William C; Goldberg, Michael J; Keith, Michael W; Turkelson, Charles M; Wies, Janet L; Raymond, Laura; Boyer, Kevin M; Hitchcock, Kristin; Anderson, Sara; Sluka, Patrick; Boone, Catherine; Patel, Nilay


    This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of osteochondritis dissecans of the knee. None of the 16 recommendations made by the work group is graded as strong; most are graded inconclusive; two are graded weak; and four are consensus statements. Both of the weak recommendations are related to imaging evaluation. For patients with knee symptoms, radiographs of the joint may be obtained to identify the lesion. For patients with radiographically apparent lesions, MRI may be used to further characterize the osteochondritis dissecans lesion or identify other knee pathology.

  10. The pathogenesis, diagnosis and treatment of Raynaud phenomenon. (United States)

    Herrick, Ariane L


    The past 10 years have seen the publication of results from several multicentre clinical trials in primary and systemic sclerosis (SSc)-related Raynaud phenomenon. The publication of these studies has occurred as a result of new insights into the pathogenesis of Raynaud phenomenon, which are directing new treatment approaches, and increased international collaboration between clinicians and scientists. Although the pathogenesis of Raynaud phenomenon is complex, abnormalities of the blood vessel wall, of neural control mechanisms and of intravascular (circulating) factors are known to interact and contribute. Key players relevant in drug development include nitric oxide, endothelin-1, alpha adrenergic receptor activation, abnormal signal transduction in vascular smooth muscle, oxidative stress and platelet activation. The main advances in diagnosis have been a clearer understanding of autoantibodies and of abnormal nailfold capillary patterns as independent predictors of SSc, and widespread use and increased availability of capillaroscopy. The ultimate aim is to translate the advances made in the pathophysiology and early diagnosis into development of treatments to prevent and reverse digital vascular dysfunction and injury. This Review provides an update of the pathogenesis, diagnosis and treatment of Raynaud phenomenon. Current and future treatment approaches are discussed, and some key unanswered questions are highlighted.

  11. Mialgias: Approaches to differential diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    Nadezhda Aleksandrovna Shostak


    Full Text Available Differential diagnosis in muscle pains often presents great difficulties so all existing signs of the disease should be carefully considered to make its diagnosis and to prescribe adequate therapy. The paper considers the causes of muscle pains, laboratory and instrumental studies (immunological tests, determination of the level of specific muscular enzymes, primarily creatine phosphokinase – CPK, etc., and the main reasons for enhanced plasma CPK activity. It also describes acute and chronic mialgias associated with enhanced plasma CPK activity, as well as diseases in which mialgias are related to the normal level of CPK, myofascial syndrome (MFS and fibromyalgia (FM in particular. The characteristic features of MFS are given in its diagnostic criteria. It is stated that a differential diagnosis should be made between MFS and major muscle pain-associated abnormalities, such as polymyalgia rheumatica, FM, etc. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

  12. Rumination syndrome: pathophysiology, diagnosis, and treatment. (United States)

    Absah, I; Rishi, A; Talley, N J; Katzka, D; Halland, M


    Rumination syndrome is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of recently ingested food from the stomach to the oral cavity followed by either re-swallowing or spitting. Rumination is thought to occur due to a reversal of the esophagogastric pressure gradient. This is achieved by a coordinated abdominothoracic maneuver consisting of a thoracic suction, crural diaphragm relaxation and an increase in intragastric pressure. Careful history is important in the diagnosis of rumination syndrome; patients often report "vomiting" or "reflux" and the diagnosis can therefore be missed. Objective testing is available with high resolution manometry or gastroduodenal manometry. Increase in intra-gastric pressure followed by regurgitation is the most important characteristic to distinguish rumination from other disorders such as gastroesophageal reflux. The mainstay of the treatment of rumination syndrome is behavioral therapy via diaphragmatic breathing in addition to patient education and reassurance. The purpose of this review was to critically appraise recent key developments in the pathophysiology, diagnosis and therapy for rumination syndrome. A literature search using OVID (Wolters Kluwer Health, New York, NY, USA) to examine the MEDLINE database its inception until May 2016 was performed using the search terms "rumination syndrome," "biofeedback therapy," and "regurgitation." References lists and personal libraries of the authors were used to identify supplemental information. Articles published in English were reviewed in full text. English abstracts were reviewed for all other languages. Priority was given to evidence obtained from randomized controlled trials when possible. © 2016 John Wiley & Sons Ltd.

  13. Diagnosis, Prevalence, Awareness, Treatment, Prevention, and Control of Hypertension in Cameroon: Protocol for a Systematic Review and Meta-Analysis of Clinic-Based and Community-Based Studies. (United States)

    Kuate Defo, Barthelemy; Mbanya, Jean Claude; Tardif, Jean-Claude; Ekundayo, Olugbemiga; Perreault, Sylvie; Potvin, Louise; Cote, Robert; Kengne, Andre Pascal; Choukem, Simeon Pierre; Assah, Felix; Kingue, Samuel; Richard, Lucie; Pongou, Roland; Frohlich, Katherine; Saji, Jude; Fournier, Pierre; Sobngwi, Eugene; Ridde, Valery; Dubé, Marie-Pierre; De Denus, Simon; Mbacham, Wilfred; Lafrance, Jean-Philippe; Nsagha, Dickson Shey; Mampuya, Warner; Dzudie, Anastase; Cloutier, Lyne; Zarowsky, Christina; Tanya, Agatha; Ndom, Paul; Hatem, Marie; Rey, Evelyne; Roy, Louise; Borgès Da Silva, Roxane; Dagenais, Christian; Todem, David; Weladji, Robert; Mbanya, Dora; Emami, Elham; Njoumemi, Zakariaou; Monnais, Laurence; Dubois, Carl-Ardy


    Hypertension holds a unique place in population health and health care because it is the leading cause of cardiovascular disease and the most common noncommunicable condition seen in primary care worldwide. Without effective prevention and control, raised blood pressure significantly increases the risk of stroke, myocardial infarction, chronic kidney disease, heart failure, dementia, renal failure, and blindness. There is an urgent need for stakeholders-including individuals and families-across the health system, researchers, and decision makers to work collaboratively for improving prevention, screening and detection, diagnosis and evaluation, awareness, treatment and medication adherence, management, and control for people with or at high risk for hypertension. Meeting this need will help reduce the burden of hypertension-related disease, prevent complications, and reduce the need for hospitalization, costly interventions, and premature deaths. This review aims to synthesize evidence on the epidemiological landscape and control of hypertension in Cameroon, and to identify elements that could potentially inform interventions to combat hypertension in this setting and elsewhere in sub-Saharan Africa. The full search process will involve several steps, including selecting relevant databases, keywords, and Medical Subject Headings (MeSH); searching for relevant studies from the selected databases; searching OpenGrey and the Grey Literature Report for gray literature; hand searching in Google Scholar; and soliciting missed publications (if any) from relevant authors. We will select qualitative, quantitative, or mixed-methods studies with data on the epidemiology and control of hypertension in Cameroon. We will include published literature in French or English from electronic databases up to December 31, 2016, and involving adults aged 18 years or older. Both facility and population-based studies on hypertension will be included. Two reviewers of the team will

  14. Laparoscopic diagnosis and treatment of nonpalpable testis

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    Francisco T. Denes


    Full Text Available INTRODUCTION: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. MATERIALS AND METHODS: We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1% had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. RESULTS: We obtained an overall 88% success rate with the 2 stage Fowler-Stephens approach and only 33% rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. CONCLUSIONS: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

  15. [Prevention and treatment of materno-fetal toxoplasmosis]. (United States)

    Fortier, B; Ajana, F; Pinto de Sousa, M I; Aissi, E; Camus, D


    Preventing congenital toxoplasmosis is fundamental, and in France screening tests for primary infection are obligatory for pregnant women. All nonimmunized women should be encouraged to follow good dietary and general health rules until delivery. Nevertheless, the risk of seroconversion does exist but can be detected early through monthly serum tests. Spiramycin as initial treatment of maternal primary infection is an essential step in preventing parasite transmission to the fetus. Fetal antitoxoplasmosis antibodies and indirect signs of congenital abnormalities should be detected early by amniotic fluid and fetal blood tests before echographic evidence confirms the diagnosis. Pyrimethamine-sulfonamide therapy should be undertaken and modulated according to laboratory results in order to prevent or treat any possible fetopathy. Congenital toxoplasmosis can be prevented in utero through biological diagnosis and specific therapy.

  16. Angiogenic factors in preeclampsia: potential for diagnosis and treatment. (United States)

    Goel, Arvind; Rana, Sarosh


    The review summarizes new observations of key roles for circulating angiogenic factors in diagnosing, managing, and treating preeclampsia. Alterations in circulating angiogenic factors (soluble fms-like tyrosine kinase-1 and placental growth factor) in preeclampsia correlate with the diagnosis and adverse outcomes, particularly when the disease presents prematurely (preeclampsia and its complications from other disorders that present with similar clinical profiles. A ratio of soluble fms-like tyrosine kinase-1/placental growth factor greater than 85 appears ideal as the cut-off for both diagnosis and prognosis. There is also evidence that modulating these factors has therapeutic effects, suggesting a future role for angiogenic factors in treatment and prevention of preeclampsia. Circulating angiogenic biomarkers help in diagnostic and prognostic profiling of preeclampsia and may facilitate better management of these patients.

  17. [Diagnosis and treatment of microangiopathic hemolytic anemia]. (United States)

    Morishita, Eriko


    "Microangiopathic hemolytic anemia (MAHA)" is now used to designate any hemolytic anemia related to RBC fragmentation, occurring in association with small vessel disease. In DIC, RBC fragmentation is thought to result from the deposition of fibrin or platelets within the microvasculature. The term "thrombotic microangiopathy (TMA)" is also used to describe syndromes characterized by MAHA, thrombocytopenia, and thrombotic lesions in small blood vessels. The most prominent diagnoses associated with TMA are thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Many different disorders, including preeclampsia, infections, adverse drug reactions, hematopoietic stem cell transplantation, autoimmune diseases, and malignancies, can cause TMA (i.e., secondary TMA). Recently, because the pathogeneses of TTP and HUS have been elucidated, great progress has been made in diagnosis and treatments. However, the pathogenesis of secondary TMA remains unclear. Clinical problems awaiting solution in TMA management include determination of the positioning of rituximab in the treatment sequence of primary TTP, management of Shiga-toxin producing Escherichia coli-HUS complicated by encephalopathy, confirmation of the efficacy and long-term safety of eculizumab in the treatment of atypical HUS, and elucidating the pathogenesis of secondary TMA as well as improving the efficacy of treatment.

  18. Tuberculous Meningitis: Diagnosis and Treatment Overview

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    Grace E. Marx


    Full Text Available Tuberculous meningitis (TBM is the most common form of central nervous system tuberculosis (TB and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid (CSF findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Nucleic acid amplification of the CSF by PCR is highly specific but suboptimal sensitivity precludes ruling out TBM with a negative test. Treatment for TBM should be initiated as soon as clinical suspicion is supported by initial CSF studies. Empiric treatment should include at least four first-line drugs, preferably isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; the role of fluoroquinolones remains to be determined. Adjunctive treatment with corticosteroids has been shown to improve mortality with TBM. In HIV-positive individuals with TBM, important treatment considerations include drug interactions, development of immune reconstitution inflammatory syndrome, unclear benefit of adjunctive corticosteroids, and higher rates of drug-resistant TB. Testing the efficacy of second-line and new anti-TB drugs in animal models of experimental TBM is needed to help determine the optimal regimen for drug-resistant TB.

  19. [Diagnosis and treatment of Chagas disease]. (United States)

    Murcia, Laura; Carrilero, Bartolomé; Saura, Daniel; Iborra, M Asunción; Segovia, Manuel


    Trypanosoma cruzi infection, or Chagas disease, was discovered more than 100 years ago by Carlos Chagas. Although the infection kills more than 15,000 people each year, it is still classified as a neglected tropical disease. Today, this disease affects eight million people in 21 Latin American countries and, due to immigration, is also present in non-endemic countries. In recent years, the size of the immigrant population with chronic imported forms of Chagas disease has increased in Spain. In addition, several cases of congenital transmission have been reported. Some patients have severe infection and require specialized treatment such as pacemaker implantation or even heart transplantation, representing a considerable clinical, social and economic burden, particularly in areas with a large immigrant population. Since the 1960s, the only drugs available for the etiological treatment of this infection have been benznidazole and nifurtimox. Although new, more effective and better tolerated compounds are urgently needed, treatment with these trypanocidal drugs is recommended in both the acute and chronic stages of Chagas disease. New strategies for diagnosis and infection control in chronically infected patients have recently been reported, allowing the effectiveness of treatments to be assessed. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  20. [Research advancement and prospects of nanotechnology in early diagnosis and treatment of cancer]. (United States)

    Hu, De-Hong; Gong, Ping; Ma, Yi-Fan; Cai, Lin-Tao


    Nanotechnology has been extensively merging into biomedical research to develop a new research field-Nanobiomedicine. It provides a unique approach and comprehensive technology against cancer by early diagnosis, prediction, prevention, personalized therapy and medicine. This review focused on the progress of nanotechnology in early diagnosis and treatment of cancer.

  1. Illicit Opioid Intoxication: Diagnosis and Treatment

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    A. Fareed


    Full Text Available Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

  2. Diagnosis and treatment of acute tubular necrosis. (United States)

    Esson, Matthew L; Schrier, Robert W


    Acute tubular necrosis (ATN) is common in hospitalized patients, particularly in the intensive care unit. Over the past four decades, the mortality rate from ATN has remained at 50% to 80%. To review recent studies of diagnosis and treatment strategies for ATN. MEDLINE search for all clinical studies of therapies for ATN, supplemented by a review of the references of the identified articles. Prospective studies and major retrospective studies evaluating therapies for ATN. Data on the study sample, interventions performed, results, side effects, and duration of follow-up. Early diagnosis of ATN by exclusion of prerenal and postrenal causes of acute renal failure, examination of urinary sediment, and analysis of urine measures (for example, fractional excretion of sodium in the absence of diuretics) can allow the early involvement of nephrologists and improve survival. Enteral rather than parenteral hyperalimentation in severely malnourished patients may improve survival. Sepsis causes 30% to 70% of deaths in patients with ATN; therefore, avoidance of intravenous lines, bladder catheters, and respirators is recommended. Because septic patients are vasodilated, large volumes of administered fluid accumulate in the lung interstitium of these patients. This condition necessitates ventilatory support, which when prolonged leads to acute respiratory distress syndrome, multiorgan failure, and increased mortality. More aggressive dialysis (for example, given daily) with biocompatible membranes may improve survival in some patients with acute renal failure. New information about the importance of early diagnosis and supportive care for patients with ATN has emerged. However, randomized trials of these interventions are needed to test their effect on the morbidity and mortality of ATN.

  3. Diagnosis and Treatment of Eosinophilic Esophagitis. (United States)

    Straumann, Alex; Katzka, David A


    Eosinophilic esophagitis (EoE) is a new disease. It is caused by a T-helper type 2 cell response to food antigens in contact with the esophageal mucosa. Although no single feature defines EoE, a constellation of compatible demographic, clinical, endoscopic, and histologic findings establish the diagnosis. Children present with symptoms and endoscopic patterns characteristic of inflammation, whereas adolescents and adults have manifestations of fibrosis and gross esophageal strictures. Clinical and endoscopic scoring systems have helped to standardize diagnosis. There is controversy in EoE research over the optimal endpoint for treatment. Although the most common endpoint is a reduced number of eosinophils in biopsies, changes in symptoms and endoscopic features are becoming important targets of therapy. We should improve our understanding of EoE progression and the need for maintenance therapy, and continue development of diagnostic tools that avoid endoscopy and biopsy analyses to more easily monitor disease activity. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  4. Diagnosis and treatment of xanthogranulomatous cholecystitis. (United States)

    Yabanoglu, H; Aydogan, C; Karakayali, F; Moray, G; Haberal, M


    The aim of this study was to review our case load of the treatment and outcomes of patients with xanthogranulomatous cholecystitis (XGC). Data about 21 patients were reviewed retrospectively to determine age, clinical symptoms and findings, preoperative screening, operative findings, surgical history, length of hospital stay, and postoperative complications. There were 14 men and 7 women (mean age, 65 ± 11.3 yr). Preoperative ultrasonography of 17 patients showed a gallbladder stone in 14 patients, adenomyomatosis plus stones in 2 patients, and a polyp in 1 patient. There were 5 patients with acute cholecystitis and 16 patients with chronic cholecystitis. Gallbladder wall thickening was noted in 3 of the 12 patients who had abdominal computed tomography. Frozen section examinations were done in 5 patients. Radical cholecystectomy was done in 1 patient because of suspected carcinoma. It is difficult to diagnose XGC preoperatively or intraoperatively, and the definitive diagnosis depends exclusively on pathologic examination.

  5. Nanotechnologies in cancer treatment and diagnosis. (United States)

    Morris, Stephanie A; Farrell, Dorothy; Grodzinski, Piotr


    Despite significant efforts toward research and treatment development, cancer continues to be a major health problem in the United States that is only further enhanced by the heterogeneous nature of the disease. Nanotechnology has evolved as a technology with applications to medicine and the potential to improve clinical outcomes, with its application to cancer garnering much attention recently. In particular, through the generation of novel nanoscale devices and therapeutic platforms, nanotechnologies have emerged as innovative approaches that enable the detection and diagnosis of cancer at its earliest stages, and the delivery of anticancer drugs directly to tumors. This article highlights recent advances in the development of nanotechnologies for cancer therapeutics and diagnostics, and focuses on the potential future of cancer nanotechnology and the challenges this young field faces as it continues to move toward clinical translation. Copyright © 2014 by the National Comprehensive Cancer Network.

  6. Prevalence, diagnosis, and treatment of ankyloglossia (United States)

    Segal, Lauren M.; Stephenson, Randolph; Dawes, Martin; Feldman, Perle


    OBJECTIVE To review the diagnostic criteria for, the prevalence of, and the effectiveness of frenotomy for treatment of ankyloglossia. DATA SOURCES MEDLINE and CINAHL databases were searched for articles suitable for a methodologic review of studies on various aspects of ankyloglossia. STUDY SELECTION Studies that presented data on patients and addressed ankyloglossia in relation to breastfeeding were selected. Case reports, case series, retrospective studies, prospective controlled studies, and randomized controlled trials were included in the analysis. Opinion pieces, literature reviews, studies without data on patients, studies that did not focus on breastfeeding, position statements, and surveys were excluded. SYNTHESIS There is no well-validated clinical method for establishinga diagnosis of ankyloglossia. Five studies using different diagnostic criteria found a prevalence of ankyloglossia of between 4% and 10%. The results of 6 non-randomized studies and 1 randomized study assessing the effectiveness of frenotomy for improving nipple pain, sucking, latch, and continuation of breastfeeding all suggested frenotomy was beneficial. No serious adverse events were reported. CONCLUSION Diagnostic criteria for ankyloglossia are needed to allow for comparative studies of treatment. Frenotomy is likely an effective treatment, but further randomized controlled trials are needed to confirm this. A reliable frenotomy decision rule is also needed. PMID:17872781

  7. Dysmenorrhea in adolescents: diagnosis and treatment. (United States)

    French, Linda


    Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1-3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.

  8. Current Diagnosis and Treatment of Anxiety Disorders (United States)

    Bystritsky, Alexander; Khalsa, Sahib S.; Cameron, Michael E.; Schiffman, Jason


    Anxiety disorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxiety disorders are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). However, each of these approaches has limitations. More recently, the emphasis in diagnosis has focused on neuroimaging and genetic research. This approach is based partly on the need for a more comprehensive understanding of how biology, stress, and genetics interact to shape the symptoms of anxiety. Anxiety disorders can be effectively treated with psychopharmacological and cognitive–behavioral interventions. These inter ventions have different symptom targets; thus, logical combinations of these strategies need to be further studied in order to improve future outcomes. New developments are forthcoming in the field of alternative strategies for managing anxiety and for treatment-resistant cases. Additional treatment enhancements should include the development of algorithms that can be easily used in primary care and with greater focus on managing functional impairment in patients with anxiety. PMID:23599668

  9. Septic arthritis in children: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Pääkkönen M


    Full Text Available Markus Pääkkönen1,2 1Department of Pediatric Orthopaedic Surgery, 2Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland Abstract: Acute septic arthritis in children is usually hematogenous. It is more common in boys, and it most often affects the large joints of the lower limb. Diagnosis is based on cultures obtained from the infected joint and is supported by C-reactive protein blood test or ultrasound imaging. Staphylococcus aureus is the most common causative agent and is the primary target for empiric treatment. First-generation cephalosporins and clindamycin are suitable antibiotics. Vancomycin is utilized in areas with high rates of clindamycin- and methicillin-resistant S. aureus. After a short intravenous administration of 2–4 days, a total course of 2 weeks is sufficient in uncomplicated cases. Early antibiotic treatment has significantly improved the prognosis in high-income settings, but uncomplicated recovery is compromised if the treatment is delayed. Complications such as symptomatic osteoarthritis or avascular necrosis of the femoral head develop slowly. A long follow-up of 1–2 years is required to detect all possible sequelae. Keywords: child, septic arthritis, sepsis, Staphylococcus aureus

  10. Diagnosis and treatment of seborrheic dermatitis. (United States)

    Clark, Gary W; Pope, Sara M; Jaboori, Khalid A


    Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

  11. Anterior canal lithiasis: diagnosis and treatment. (United States)

    Casani, Augusto Pietro; Cerchiai, Niccolò; Dallan, Iacopo; Sellari-Franceschini, Stefano


    To describe the clinical and oculographic features in patients with anterior semicircular canal benign paroxysmal positional vertigo and to determine the efficacy of a canalith repositioning procedure for its management. Case series with chart review of patients presenting positional vertigo and positional downbeating nystagmus during a 2-year period. Outpatients' tertiary referral center for balance disorders. Eighteen patients suffering from positional vertigo and presenting positional downbeating nystagmus were treated with a maneuver based on a modification of the procedure proposed by Crevits. disappearance of positional downbeating nystagmus. Positional downbeating nystagmus was elicited unilaterally with the Dix-Hallpike maneuver in 6 cases. In 4 patients, it was triggered by both left and right Dix-Hallpike tests. In 8 patients, the positional nystagmus was elicited by a straight head-hanging maneuver. The positional nystagmus was purely downbeating in 12 patients. In the remaining, a torsional component was detected. After the treatment, only 1 patient showed positional nystagmus at 30 days. In anterior canal benign paroxysmal positional vertigo, the presence of a positional downbeating nystagmus in response to positional tests is key for diagnosis. In a significant number of patients, the affected side may not be detected because of the inconstant presence of a torsional component. Treatment with a simplified maneuver based on Crevits's technique can be considered an effective method for the treatment of anterior canal lithiasis, especially when the affected side cannot be detected clearly.


    Directory of Open Access Journals (Sweden)

    M. S. Savenkova


    Full Text Available Diagnostics of intrauterine infection associated with T. gondii, today is a task with an ambiguous solution for different specialists — gynecologists, obstetricians, neonatologists, infectious disease specialists, resuscitators. This problem is interdisciplinary, and its coordinated decision, diagnosis and treatment of this disease at an early stage will reduce the risk of stillbirths, deaths and severe consequences. The article reflects the current literature data on the clinical features of toxoplasmosis in relation to the genotype of Toxoplasmа, circulating in the world. Particular importance is given to the selection of methods for prenatal and postnatal diagnosis of toxoplasmosis. The data of the latest review (2017 of theAmericanAcademy of Pediatrics on the diagnosis, treatment and prevention of congenital toxoplasmosis are presented. The main clinical manifestations of toxoplasmosis were revealed. Basic preparations for treatment of toxoplasmosis is Trimethoprim + sulfamethoxazole (Biseptol and spiramycin (Rovamycin.

  13. The diagnosis and treatment of eating disorders. (United States)

    Herpertz, Stephan; Hagenah, Ulrich; Vocks, Silja; von Wietersheim, Jörn; Cuntz, Ulrich; Zeeck, Almut


    Eating disorders are of major significance both in clinical medicine and in society at large. Anorexia and bulimia nervosa almost exclusively afflict young persons, severely impairing their physical and mental health. The peak ages for these diseases are in late adolescence and young adulthood; patients therefore suffer setbacks both in school and/or in their occupational careers. This scientifically based S3 guideline was developed with the intention of improving the treatment of eating disorders and motivating future research in this area. The existing national and international guidelines on the three types of eating disorders were synoptically compared, the literature on the subject was systematically searched, and meta-analyses on bulimia nervosa and binge-eating disorder were carried out. 15 consensus conferences were held, as a result of which 44 evidence-based recommendations were issued. Anorexia and bulimia nervosa are diagnosed according to the ICD-10 criteria (International Classification of Diseases), binge-eating disorder according to those of the DSM (Diagnostic and Statistical Manual of Mental Disorders). Psychotherapy is the mainstay of treatment for all three disorders, and cognitive behavioral therapy is the form of psychotherapy best supported by the available evidence. The administration of selective serotonin reuptake inhibitors (SSRI) can be recommended as a flanking measure in the treatment of bulimia nervosa only. The evidence does not support any type of pharmacotherapy for anorexia nervosa or binge-eating disorder. Bulimia nervosa and binge-eating disorder can usually be treated on an outpatient basis, as long as they are no more than moderately severe; full-fledged anorexia nervosa is generally an indication for in-hospital treatment. This guideline contains evidence- and consensus-based recommendations for the diagnosis and treatment of eating disorders. If strictly implemented, it should result in improved care for the affected

  14. Cyanide: critical issues in diagnosis and treatment. (United States)

    Baud, F J


    The concern of a terrorist attack using cyanide, as well as the gradual awareness of cyanide poisoning in fire victims, has resulted in a renewed interest in the diagnosis and treatment of cyanide poisoning. The formerly academic presentation of cyanide poisoning must be replaced by more useful knowledge, which will allow emergency physicians and rescue workers to strongly suspect cyanide poisoning at the scene. Human cyanide poisonings may result from exposure to cyanide, its salts, or cyanogenic compounds, while residential fires are the most common condition of exposure. In fire victims, recognition of the cyanide toxidrome has been hampered by the short half-life in blood and poor stability of cyanide. In contrast, carboxyhemoglobin, as a marker of carbon monoxide poisoning, is easily measured and long-lasting. No evidence supports the assumption of the arbitrary fixed lethal thresholds of 50% for carboxyhemoglobin, and 3 mg/L for cyanide, in fire victims. Preliminary data, drawn when comparing pure carbon monoxide and pure cyanide poisonings, suggest that a cyanide toxidrome can be defined considering signs and symptoms induced by cyanide and carbon monoxide, respectively. Prospective studies in fire victims may provide value in clarifying signs and symptoms related to both toxicants. Cyanide can induce a life-threatening poisoning from which a full recovery is possible. A number of experimentally efficient antidotes to cyanide exist, whose clinical use has been hampered due to serious side effects. The availability of potentially safer antidotes unveils the possibility of their value as first-line treatment, even in a complex clinical situation, where diagnosis is rapid and presumptive.

  15. Current Diagnosis and Treatment of Halitosis

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    Mehmet Mustafa Kılıçkaya


    Full Text Available Halitosis or oral malodor is not a diagnosis, but is symptom. Halitosis, that we frequently encounter in ear, nose and throat practice can be the harbinger of some serious underlying disease. Therefore, diagnosis and to find the cause of the halitosis are important. Also halitosis treatment is necessary due to the social and psychological effects. Breath contains hundreds of volatile organic compounds that are by-products of our metabolism. Certain diseases such as nasopharynx cancer, larynx cancer ve lung cancer alter the mix of gases. Thus, the analysis of exhaled air has gained importance. New technologies lead to the development of new devices. And with these called electronic noses the analysis of exhaled air has becomes an important non-invasive diagnostic method. In the literature, halitosis and bad breath which is used as synonymus with oral malodor is the emission of unpleasant odor from mouth and nasal passage. It occurs in 25% of the population, approximately and it has a significant social and economic impact. Halitosis is classified as true halitosis (physiologic halitosis and pathologic halitosis, pseudohalitosis and halitophobia. The most common cause is intra-oral diseases. Among all these factors, the most important etiologic factor are the coating tongue. Other ear, nose and throat diseases such as rhinitis and sinusitis are seen among the most common extraoral causes. Treponema denticola, Porphyromonas gingivalis, Tanneralla forsythia, Fusobacterium nucleatum, Prevotella intermedia, Prevotella nigrescens, Actinobacilli and Solobacterium moorei are the bacteria which are commonly isolated from patients with halitosis and they are volatile sulfur compounds (VSCs producing ones as well. The treatment of halitosis should be carried out according to the etiology. In the physiologic halitosis tooth brushing, use of dental floss, tongue cleaning and chlorhexidine, cetylpyridinium chloride and zinc containing antimicrobial mouthwashes

  16. Brazilian guidelines for the diagnosis and treatment of postmenopausal osteoporosis

    Directory of Open Access Journals (Sweden)

    Sebastião Cézar Radominski

    Full Text Available Abstract Osteoporosis is the leading cause of fractures in the population older than 50 years. This silent disease affects primarily postmenopausal women and the elderly, and the morbidity and mortality rates are high. The main goal of treating osteoporosis is the prevention of fractures. The identification of populations at risk through early diagnosis and treatment is essential. The last Brazilian guideline for the treatment of postmenopausal osteoporosis was elaborated in 2002. Since then, new strategies for diagnosis and risk stratification have been developed, and drugs with novel action mechanisms have been added to the therapeutic arsenal. The Osteoporosis and Osteometabolic Diseases Committee of the Brazilian Society of Rheumatology, in conjunction with the Brazilian Medical Association and other Societies, has developed this update of the guidelines for the treatment of postmenopausal osteoporosis according to the best scientific evidence available. This update is intended for professionals in many medical and health specialties involved in the treatment of osteoporosis, for physicians in general and for health-related organizations.

  17. Brazilian guidelines for the diagnosis and treatment of postmenopausal osteoporosis. (United States)

    Radominski, Sebastião Cézar; Bernardo, Wanderley; Paula, Ana Patrícia de; Albergaria, Ben-Hur; Moreira, Caio; Fernandes, Cesar Eduardo; Castro, Charlles H M; Zerbini, Cristiano Augusto de Freitas; Domiciano, Diogo S; Mendonça, Laura M C; Pompei, Luciano de Melo; Bezerra, Mailze Campos; Loures, Marco Antônio R; Wender, Maria Celeste Osório; Lazaretti-Castro, Marise; Pereira, Rosa M R; Maeda, Sergio Setsuo; Szejnfeld, Vera Lúcia; Borba, Victoria Z C


    Osteoporosis is the leading cause of fractures in the population older than 50 years. This silent disease affects primarily postmenopausal women and the elderly, and the morbidity and mortality rates are high. The main goal of treating osteoporosis is the prevention of fractures. The identification of populations at risk through early diagnosis and treatment is essential. The last Brazilian guideline for the treatment of postmenopausal osteoporosis was elaborated in 2002. Since then, new strategies for diagnosis and risk stratification have been developed, and drugs with novel action mechanisms have been added to the therapeutic arsenal. The Osteoporosis and Osteometabolic Diseases Committee of the Brazilian Society of Rheumatology, in conjunction with the Brazilian Medical Association and other Societies, has developed this update of the guidelines for the treatment of postmenopausal osteoporosis according to the best scientific evidence available. This update is intended for professionals in many medical and health specialties involved in the treatment of osteoporosis, for physicians in general and for health-related organizations. Copyright © 2017. Published by Elsevier Editora Ltda.

  18. Haemophilus influenzae Disease (Including Hib) Diagnosis and Treatment (United States)

    ... Search Form Controls Cancel Submit Search The CDC Haemophilus influenzae Disease (Including Hib) Note: Javascript is disabled or ... Page Diagnosis Treatment Complications Diagnosis Doctors usually diagnose Haemophilus influenzae , including H. influenzae type b or Hib, infection ...

  19. Allergy Diagnosis and Treatment | NIH MedlinePlus the Magazine (United States)

    ... this page please turn Javascript on. Feature: Managing Allergies Allergy Diagnosis and Treatment Past Issues / Spring 2013 Table of Contents Diagnosis Testing for Allergies Knowing exactly what you are allergic to can ...

  20. Diabetes Prevention and Treatment Strategies


    Backholer, Kathryn; Peeters, Anna; Herman, William H.; Shaw, Jonathan E.; Liew, Danny; Ademi, Zanfina; Magliano, Dianna J.


    OBJECTIVE Effective interventions to prevent, delay, or remit diabetes are currently available. However, their impact on the prevalence of diabetes at the population level is unknown. This study aimed to estimate the impact of a range of diabetes interventions on the population prevalence of diabetes for Australian adults between 2010 and 2025. RESEARCH DESIGN AND METHODS We used the Australian Diabetes Projection Model to estimate the impact of a population-wide strategy, high-risk preventio...

  1. Diagnosis and treatment of chondroblastoma: Our experience

    Directory of Open Access Journals (Sweden)

    Slavković Slobodan


    Full Text Available The paper presented the results of diagnostics and treatment of patients with diagnosis of chondroblastoma, treated at the Institute of Orthopedic Surgery "Banjica", Belgrade. A total of 30 patients were analyzed, involving the period from 1975-2004. All important data were obtained using the complete medical documentation, physical examination, radiographic findings and available additional diagnostic procedures. The proximal part of tibia, the proximal part of humerus and the distal part of femur were the most common sites of tumor, accounting for 63% of cases. Higher incidence of chondroblastoma was found in male patients, especially in the second decade of life. Pathohistological tumor verification was done in all patients. The patients were then treated by different surgical procedures, both on account of primary lesion and recurrence. Curettage and osteoplasty using the auto- and homograft were carried out in 21 patients, wide resection in nine cases, and amputation was performed in three cases. One patient had radiotherapy due to recurrence of lesion, nevertheless malignant transformation of chondroblastoma occurred in time. Seven patients manifested local recurrence, and one of them even had relapse on two occasions and malignant transformation of chondroblastoma. Malignant lesions were found in three cases (10% of patients; one lesion was diagnosed as primary while other two malignancies were detected only after recurrence, and the treatment was completed by lower leg amputation.

  2. School Refusal: Clinical Features, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Kayhan Bahali


    Full Text Available Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child’s inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child’s academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of

  3. Toxoplasmosis in pregnancy: prevention, screening, and treatment. (United States)

    Paquet, Caroline; Yudin, Mark H


    One of the major consequences of pregnant women becoming infected by Toxoplasma gondii is vertical transmission to the fetus. Although rare, congenital toxoplasmosis can cause severe neurological or ocular disease (leading to blindness), as well as cardiac and cerebral anomalies. Prenatal care must include education about prevention of toxoplasmosis. The low prevalence of the disease in the Canadian population and limitations in diagnosis and therapy limit the effectiveness of screening strategies. Therefore, routine screening is not currently recommended. To review the prevention, diagnosis, and management of toxoplasmosis in pregnancy. OUTCOMES evaluated include the effect of screening on diagnosis of congenital toxoplasmosis and the efficacy of prophylaxis and treatment. The Cochrane Library and Medline were searched for articles published in English from 1990 to the present related to toxoplasmosis and pregnancy. Additional articles were identified through references of these articles. The quality of evidence is rated and recommendations made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table). Guideline implementation should assist the practitioner in developing an approach to screening for and treatment of toxoplasmosis in pregnancy. Patients will benefit from appropriate management of this condition. The Society of Obstetricians and Gynaecologists of Canada. 1. Routine universal screening should not be performed for pregnant women at low risk. Serologic screening should be offered only to pregnant women considered to be at risk for primary Toxoplasma gondii infection. (II-3E) 2. Suspected recent infection in a pregnant woman should be confirmed before intervention by having samples tested at a toxoplasmosis reference laboratory, using tests that are as accurate as possible and correctly interpreted. (II-2B) 3. If acute infection is suspected, repeat testing should be performed within 2 to 3 weeks, and consideration

  4. Intracranial atherosclerosis: Causes of ischemic stroke, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    V.A Sorokoumov


    Full Text Available The paper reviews the literature on the identification of the causes of ischemic stroke and transient ischemic attacks in intracranial atherosclerosis. Symptomatic intracranial atherosclerosis is the cause of an ischemic focus in not only the cortical and subcortical structures due to hypoperfusion or arterio-arterial embolism, but also in the deep structures of the cerebral hemispheres and brainstem. Major artery dolichoectasia may make an accurate diagnosis and treatment choice difficult.Progress in the treatment of patients with symptomatic intracranial atherosclerosis depends on the availability of current brain and vessel imaging techniques and cranial artery angioplasty and stenting methods. The efficiency of aggressive medical prevention, primarily blood pressure reduction and different combinations of antiplatelet drugs, is being intensively investigated.

  5. [Clinical practice guideline. Diagnosis and treatment of dyslipidemia. (United States)

    Canalizo-Miranda, Elvia; Favela-Pérez, Eddie Alberto; Salas-Anaya, Javier Alejandro; Gómez-Díaz, Rita; Jara-Espino, Ricardo; Del Pilar Torres-Arreola, Laura; Viniegra-Osorio, Arturo


    Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.

  6. [Mallory-Weiss syndrome: diagnosis and treatment]. (United States)

    Lecleire, Stéphane; Antonietti, Michel; Ducrotté, Philippe


    Mallory-Weiss syndrome is relatively common and is involved in 3 to 10% of cases of upper gastrointestinal bleeding. Most of the time, the hemorrhage is mild and stops spontaneously. Clinical suspicion requires confirmation by an upper gastrointestinal endoscopy, which must be performed rapidly after the first hematemesis. Mallory-Weiss syndrome is diagnosed when it shows a longitudinal mucosal tear at the esophagogastric junction. Patients with active bleeding or signs of recent bleeding at endoscopy need immediate endoscopic treatment for hemostasis. Band ligation seems to be the most efficient procedure for primary hemostasis and for preventing recurrent bleeding. The use of proton pump inhibitors and antiemetics seems logical in all cases, although nothing in the literature demonstrates their efficacy. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  7. Diagnosis and treatment of schizophrenia in a general hospital ...

    African Journals Online (AJOL)

    Future standard operational procedures for diagnostic and treatment processes in acute wards may have to include structured interviews in order to enhance the quality of the routine process of diagnosis and treatment of patients with schizophrenia. Key words: Acute management; Schizophrenia; Diagnosis; Treatment; ...

  8. Impetigo: Tips for Treatment and Prevention (United States)

    ... DO Videos Contact Close ‹ Back to Healthy Living Impetigo: Tips for Treatment and Prevention The symptoms of ... to other parts of their bodies. Causes of Impetigo Impetigo usually affects preschool and school-aged children, ...

  9. Kawasaki Disease: Complications, Treatment and Prevention (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Kawasaki Disease: Complications, Treatment and Prevention Updated:May 8, ... possibility of heart and coronary artery involvement makes Kawasaki disease unpredictable, but these problems usually are not ...

  10. Prevention and treatment of postmenopausal osteoporosis. (United States)

    Tella, Sri Harsha; Gallagher, J Christopher


    In the beginning, that is from the 1960's, when a link between menopause and osteoporosis was first identified; estrogen treatment was the standard for preventing bone loss, however there was no fracture data, even though it was thought to be effective. This continued until the Women's Health Initiative (WHI) study in 2001 that published data on 6 years of treatment with hormone therapy that showed an increase in heart attacks and breast cancer. Even though the risks were small, 1 per 1500 users annually, patients were worried and there was a large drop off in estrogen use. In later analyses the WHI study showed that estrogen reduced fractures and actually prevented heart attacks in the 50-60 year age group. Estrogen alone appeared to be safer to use than estrogen+the progestin medroxyprogesterone acetate and actually reduced breast cancer. At the same time other drugs were being developed for bone that belong to the bisphosphonate group and the first generation of compounds showed moderate potency on bone resorption. The second and third generation compounds were much more potent and in a series of large trials were shown to reduce fractures. For the last 15 years the treatment of osteoporosis belonged to the bisphosphonate compounds, most of which reduce fracture rates by 50 percent. With the exception of gastrointestinal irritation the drugs are well tolerated and highly effective. The sophistication of the delivery systems now allow treatment that can be given daily, weekly, monthly and annually either orally or intravenously. Bone remodeling is a dynamic process that repairs microfractures and replaces old bone with new bone. In the last 10 years there has been a remarkable understanding of bone biology so that new therapies can be specifically designed on a biological basis. The realization that RANKL was the final cytokine involved in the resorption process and that marrow cells produced a natural antagonist called Osteoprotegerin (OPG) quickly led to two

  11. Bromadiolone toxicokinetics: diagnosis and treatment implications. (United States)

    Lo, Vanessa M H; Ching, C K; Chan, Albert Y W; Mak, Tony W L


    Ingestion of bromadiolone can lead to prolonged and life-threatening coagulopathy. Traditional treatment of bromadiolone intoxication relies on the coagulation profile. Currently, there is scanty information on bromadiolone elimination kinetics and half-life. We report a case of bromadiolone poisoning in a 40-year old female who, by history, ingested four 42.5-gram bags of rat poison (0.005% bromadiolone), equivalent to 8.5 mg bromadiolone (0.17 mg/kg body weight), four days prior to admission. On admission, her prothrombin time was 92.0 seconds, international normalized ratio was 5.7, and activated partial thromboplastin time was 50.2 seconds with no bleeding on clinical examination. The first plasma bromadiolone level (5 days post-ingestion) was 92 ng/mL. Serial measurement of plasma bromadiolone levels confirmed the diagnosis and demonstrated that bromadiolone obeys the elimination kinetic of a two-compartment model with a rapid, fairly steep decline phase (half-life 3.5 days) followed by a slower termination phase (half-life 24 days). Plasma bromadiolone level of less than 10 ng/mL in our patient was associated with a consistently normal coagulation profile without vitamin K1 therapy. There is a lack of information on the toxicodynamics and toxicokinetics of bromadiolone in humans; further studies are needed before the plasma bromadiolone level can serve as one of the logical and safe therapeutic endpoints for vitamin K1 therapy.

  12. Narcolepsy: etiology, clinical features, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Jolanta B. Zawilska


    Full Text Available [u][/u] Narcolepsy is a chronic hypersomnia characterized by excessive daytime sleepiness (EDS and manifestations of disrupted rapid eye movement sleep stage (cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid. An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i.e., cerebrospinal fluid hypocretin-1 levels and expression of the DQB1*0602 gene, are used. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamine-like, modafinil and armodafinil. Cataplexy is treated with sodium oxybate (GHB, tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

  13. Soft tissue sarcoma - diagnosis and treatment

    International Nuclear Information System (INIS)

    Ruka, W.; Rutkowski, P.; Krzakowski, M.


    Significant progress in the treatment of soft tissue sarcoma (STS), both primary tumor and local recurrences/metastatic disease, has been achieved in recent years. Surgery is essential modality, but the use of combined treatment (standard combination of surgery with adjuvant radiotherapy, chemotherapy in selected cases and perioperative rehabilitation) in highly-experienced centers increased possibility of cure and limitations of extent of local surgery. Current combined therapy together with the use of reconstructive methods allows for limb-sparing surgery in majority of soft tissue sarcoma patients (amputation in 10% of cases as compared to approximately 50% in the 1960 - 70s). The slow, but constant, increase of rate of soft tissue sarcoma patients with long-term survival has been observed. Contemporary 5-year overall survival rate in patients with extremity soft tissue sarcomas is 55 -78%. In case of diagnosis of metastatic disease the prognosis is still poor (survival of approximately 1 year). Good results of local therapy may be expected only after planned (e.g., after preoperative biopsy - tru - cut or incisional) radical surgical excision of primary tumor with pathologically negative margins (R0 resection). Following appropriate diagnostic check-up, adjuvant radiotherapy is necessary in the majority of patients treated with radical surgery need, as well as long-term rehabilitation and follow-up examinations in treating center are needed for at least 5 years. The progress is due to the introduction of targeted therapy acting on molecular or genetic cellular disturbances detected during studies on etiopathogenetic mechanisms of sarcoma subtypes. In view of rarity of sarcomas and necessity of multidisciplinary therapy, the crucial issue is that management of these tumors should be hold in experienced oncological sarcoma centers. (authors)

  14. Psychosocial risks in university education teachers: Diagnosis and prevention

    Directory of Open Access Journals (Sweden)

    María Matilde García


    Full Text Available The aim of this study is to assess the psychosocial risks of university teachers and identify enhancement areas for a healthy organization in a sample of 621 teachers from the University of A Coruña, Spain. To achieve this aim, the Copenhagen Psychosocial Questionnaire (CoPsoQ adapted to the Spanish population (ISTAS21 Method was applied. The results showed an unfavorable situation for psychosocial health in five dimensions: high psychological demands, low esteem, high double presence, low social support, and high job insecurity. In contrast, a favorable situation for health is the dimension active work and development opportunities. It was also found that there is not a single profile of university teacher in psychosocial risk. To conclude, a diagnosis of psychosocial risks of university teachers is made and, in that scenario, some risk prevention strategies at university level are proposed.

  15. Drug Treatment as HIV Prevention: Expanding Treatment Options


    Metzger, David S.; Zhang, Yan


    Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data has emerged suggesting the preventi...

  16. Diagnosis and office-based treatment of urinary incontinence in adults. Part one: diagnosis and testing. (United States)

    Cameron, Anne P; Heidelbaugh, Joel J; Jimbo, Masahito


    Urinary incontinence is a common problem in both men and women. This review article addresses its prevalence, risk factors, cost, the various types of incontinence, as well as how to diagnose them. The US Preventive Services Task Force, the Cochrane Database of Systematic Reviews, and PubMed were reviewed for articles focusing on urinary incontinence. Incontinence is a common problem with a high societal cost. It is frequently underreported by patients so it is appropriate for primary-care providers to screen all women and older men during visits. A thorough history and physical examination combined with easy office-based tests can often yield a clear diagnosis and rule out other transient illnesses contributing to the incontinence. Specialist referral is occasionally needed in specific situations before embarking on a treatment plan.

  17. Retinoblastoma: genetics, diagnosis, treatment and sequelae

    International Nuclear Information System (INIS)

    Halperin, Edward C.


    retinoblastoma treatment is cure. It is reasonable to assert that a secondary goal of treatment is preservation of vision in the affected eye. Surgical options for therapy include enucleation, exenteration, photo coagulation, cryotherapy, and radioactive plaque application. External beam radiotherapy has a significant role to play in sight-preserving therapy. There has been a resurgence of interest in the use of systemic cytotoxic chemotherapy, either in addition to conventional surgical and radiotherapy techniques or as an alternative to them. The RB1 gene unequivocally is involved in carcinogenesis. Heritable retinoblastoma has an appreciable rate of second malignant neoplasm development - the cumulative mortality for all second tumors at 40 years of follow-up for bilateral retinoblastoma has been calculated to be 26%. Therapy choice may influence the risk and type of second malignant neoplasms. This refresher course will survey the genetic basis of retinoblastoma, techniques of diagnosis, forms of therapy, and the long-term consequences of cure of this fascinating childhood malignancy

  18. Retinoblastoma: Genetics, diagnosis, treatment and sequelae

    International Nuclear Information System (INIS)

    Halperin, Edward C.


    retinoblastoma treatment is cure. It is reasonable to assert that a secondary goal of treatment is preservation of vision in the affected eye. Surgical options for therapy include enucleation, exenteration, photo coagulation, cryotherapy, and radioactive plaque application. External beam radiotherapy has a significant role to play in sight-preserving therapy. There has been a resurgence of interest in the use of systemic cytotoxic chemotherapy, either in addition to conventional surgical and radiotherapy techniques or as an alternative to them. Several ophthalmic oncology centers have piloted therapy programs designed to avoid enucleation or whole eye external beam irradiation. Such programs rely on vigorous focal therapy plus chemotherapy. The RB1 gene unequivocally is involved in carcinogenesis. Heritable retinoblastoma has an appreciable rate of second malignant neoplasm development - the cumulative mortality for all second tumors at 40 years of follow-up for bilateral retinoblastoma has been calculated to be 26%. Therapy choice may influence the risk and type of second malignant neoplasms. This refresher course will survey the genetic basis of retinoblastoma, techniques of diagnosis, forms of therapy, proposals for protocols emphasizing chemotherapy plus focal therapy, and the long-term consequences of cure of this fascinating childhood malignancy

  19. Optimal diagnosis, prevention, and management of periprosthetic joint infection

    Directory of Open Access Journals (Sweden)

    Tafer N


    Full Text Available Nathalie Tafer,1 Wilson Belaieff,1 Céline Cuérel,1 Matthieu Zingg,1 Pierre Hoffmeyer,1 Ilker Uçkay1,2 1Orthopedic Surgery Department, 2Division of Infectious Diseases, University of Geneva Hospitals and Medical School, Geneva, Switzerland Abstract: The pace of the aging population is steadily rising worldwide with a parallel increase in the demand for joint replacement procedures. With the increasing number of patients undergoing arthroplasty, there is also an increased risk for arthroplasty infection that may lead to severe complications, poorer outcome, and substantial extra costs for health care systems. Current rates of prosthetic joint infection are not dramatically different from the 1960s or 1970s, but some general principles are now better defined, and their management has been studied extensively during the past decades, thus resulting in a change in clinical practice. The purpose of this review is to summarize important principles of prosthetic joint infection to guide the clinician and to contribute to the optimal diagnosis, prevention, and management of periprosthetic joint infections. Keywords: arthroplasty infection, antibiotic therapy, biofilm, surgery, prevention

  20. Clinical diagnosis and treatment of ectopic pregnancy. (United States)

    Alkatout, Ibrahim; Honemeyer, Ulrich; Strauss, Alexander; Tinelli, Andrea; Malvasi, Antonio; Jonat, Walter; Mettler, Liselotte; Schollmeyer, Thoralf


    Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain, or a combination of the 2 is between 6% and 16%. DESIGNATION: Workup of all localizations of ectopic pregnancies at a university department of obstetrics and gynecology. Comparison of diagnostic and therapeutic modalities from the surgical laparoscopic approach to nonsurgical, medical options. Tubal pregnancies: (1) to preserve tubal function, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis, or fimbrial milking is performed. (2) Tubectomy or salpingectomy is performed only in severely damaged or ruptured tubes or if the patient does not desire further pregnancies. Nontubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment. The predominant drug is methotrexate, but other systemic drugs, such as actinomycin D, prostaglandins, and RU 486, can also be applied. Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection. This article is a review to aid clinical diagnosis of ectopic pregnancies that now can be diagnosed earlier and treated effectively by laparoscopic surgery.

  1. Adults attending private physiotherapy practices seek diagnosis, pain relief, improved function, education and prevention: a survey. (United States)

    McRae, Martin; Hancock, Mark J


    How important are different aspects of physiotherapy care to patients presenting to a primary care physiotherapist? Are patient factors (eg, age and gender) associated with how important different aspects of physiotherapy care are to individual patients? A cross-sectional survey with consecutive recruitment. A total of 500 adults aged≥18years who presented to a primary care physiotherapist. Participants were recruited from 10 private practices within the Sydney metropolitan area. Participants completed a survey assessing how important five aspects of physiotherapy care were in their initial decision to present to a primary care physiotherapist. These aspects were: diagnosis; information and education; treatment for pain relief; treatment to improve function; and prevention. The survey also collected characteristics of the patients and information about their presentation to the physiotherapist, to assess whether these factors were associated with the aspects of physiotherapy care that they considered most important. A total of 500 surveys were completed, with a response rate of 94%. All five aspects of physiotherapy care were considered either 'quite important' or 'extremely important' by most participants (diagnosis 65%; information and education 68%; pain relief 89%; improved function 93%; prevention 90%). Patient factors were associated with the participants' ratings of importance. Female participants and those with spinal pain more commonly rated pain relief as highly important. Participants with lower educational levels were more likely to rate diagnosis and information and education as important. This study demonstrated that most patients presenting to primary care physiotherapists value all aspects of physiotherapy care and do not simply want treatment for pain. Patient characteristics were associated with what individual patients considered the most important reason for presenting to a private primary care physiotherapist. [McRae M, Hancock MJ (2017

  2. [Safety in the diagnosis and treatment of inflammatory bowel disease]. (United States)

    Gomollón, Fernando


    The presentations at Digestive Disease Week 2013 emphasized treatment safety. Anti-tumor necrosis factor (TNF) agents and thiopurines are reasonably safe in breastfeeding and pregnancy. Several studies indicate that controlling the risk of tuberculosis when anti-TNF agents are planned presents several problems, both in the initial diagnosis of latent tuberculosis and in subsequent patient follow-up, given that cases of tuberculosis continue to occur, despite recommendations. Thiopurines increase the risk of lymphoma, but there is no residual risk when these drugs are withdrawn. Despite increasing knowledge of the risks and recommendations on how to avoid them, there remain considerable shortfalls in the application of preventive measures and, more specifically, in vaccinations. Infliximab and cyclosporin produce similar results when used to treat severe outbreaks of ulcerative colitis. Thromboembolism prevention continues to be deficient, and the barriers to effective prevention concern not only physicians but can also involve nursing staff, for example. There is still a wide margin for improvement in safety. New drugs under study (vedolizumab, golimumab) have not shown any hitherto unknown signs of significant toxicity. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  3. Advances in the diagnosis and treatment of pediatric acute pancreatitis

    Directory of Open Access Journals (Sweden)

    WU Jie


    Full Text Available The incidence rate of acute pancreatitis (AP has been gradually increasing in recent years, and pediatric AP is often seen in clinical practice. Pediatric AP has complex causes and diverse clinical manifestations, and infants and children cannot clearly explain their discomforts, which makes it more difficult to make an accurate diagnosis and may easily cause misdiagnosis, missed diagnosis, and delayed treatment. A deep understanding of pediatric AP helps to improve the diagnosis and treatment level of this disease. This article reviews the advances in the diagnosis and treatment of pediatric AP, in order to provide guidance to clinical practice.

  4. Advances in the Diagnosis and Treatment of Acanthamoeba Keratitis

    Directory of Open Access Journals (Sweden)

    Benjamin Clarke


    Full Text Available This paper aims to review the recent literature describing Acanthamoeba keratitis and outline current thoughts on pathogenesis, diagnosis, and treatment as well as currently emerging diagnostic and treatment modalities.

  5. Diagnosis and treatment of chronic thromboembolic pulmonary hypertension in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Charles Marinus; Mellemkjær, Søren; Nielsen-Kudsk, Jens Erik


    Chronic thromboembolic pulmonary hypertension (CTEPH) is an important differential diagnosis in patients with unexplained dyspnoea. CTEPH is under-recognized and carries a poor prognosis without treatment. Surgical pulmonary endarterectomy is the preferred treatment for the majority of patients...

  6. Diagnosis and Treatment of Influenza in Children

    Directory of Open Access Journals (Sweden)

    M. S. Savenkova


    Full Text Available The article presents data on influenza epidemiology, pathogenesis, classification, clinical variants, diagnosis. Given the variety of antiviral drugs, highlighted the most relevant and used in pediatric patients, depending on age and mixed-flow options viral infections.

  7. Treatment and Prevention of Neonatal Anemia


    Widness, John A.


    Because red blood cell (RBC) transfusion therapy remains the primary treatment of anemia encountered in early life, the basis for RBC transfusion in the treatment of symptomatic anemia is discussed in this review along with several important aspects of neonatal blood banking practices. Nontransfusion approaches to the prevention and treatment of neonatal anemia also are described. Finally, this review covers the controversy surrounding whether neonatal RBC transfusion therapy should be restri...

  8. The diagnosis and treatment of the gummy smile. (United States)

    Levine, R A; McGuire, M


    The diagnosis and treatment of the "gummy smile" (altered passive eruption, excessive gingival display) help the periodontist to provide the most beautiful smiles possible for patients. This article describes diagnosis, surgical planning, and case reports that show the benefits of treatment of this common clinical problem for the patient and restorative dentist who can now provide ideal cosmetic results for their patients.

  9. An update on the diagnosis and treatment of dens invaginatus

    NARCIS (Netherlands)

    Zhu, J.; Wang, X.; Fang, Y.; Hoff, J.W. Von den; Meng, L.


    Dens invaginatus is a malformation with varying anatomical features, posing challenges to treatment. Early and accurate diagnosis plays a significant role in selecting the appropriate treatment. The diagnosis of teeth with a complex root canal system including dens invaginatus has made progress with

  10. Diagnosis and Treatment of Inguinoscrotal Hernias in Children

    Directory of Open Access Journals (Sweden)

    O.V. Spakhi


    Conclusions. 1. The optimal duration of the surgery is the time of diagnosis with a view to preventing complications and damage of the scrotal organs. 2. Laparoscopic access allows you to easily perform the operation on both sides, which, in turn, prevents the occurrence of contralateral hernia in catamnesis.

  11. Diagnosis, surgical treatment and follow-up of thyroid cancers

    International Nuclear Information System (INIS)

    Pacini, F.; Pinchera, A.; Vorontsova, T.; Demidchik, E.P.; Delange, F.; Reiners, C.; Schlumberger, M.


    This paper reports the activities and the results of the research carried out by the Centers participating to the JSP4 project, within the framework of the EU program on the consequences of the Chernobyl disaster. The project was aimed to develop and to control the application of basic principles for the diagnosis, treatment and follow-up of thyroid carcinoma, with special attention to the peculiar requirement of children and adolescents. To this purpose, training in Western European Centers was offered to a number of scientists from Belarus, Ukraine and Russia. Several official meetings were organized to share views and to discuss the progress of the project. A basic protocol for the diagnosis, treatment and follow-up of thyroid carcinoma has been developed and approved by all participating Centers. Hopefully, it will be applied to the new cases and to those already under monitoring. A large part of the protocol is dedicated to the post-surgical treatment with thyroid hormones for the suppression of TSH and with calcitriol for the management of surgical hypoparathyroidism. A detailed protocol to asses iodine deficiency and, eventually, to introduce a program of iodine supplementation has been proposed. The collection of control cases of childhood thyroid carcinoma in non-radiation exposed European countries has been initiated in Italy, France and Germany. This data will be used as control for the post-Chernobyl childhood thyroid carcinomas. Here is reported a preliminary comparison of the clinical and epidemiological features of almost all (n=368) radiation-exposed Belarus children who developed thyroid carcinoma (age at diagnosis < 16 years), with respect to 90 children of the same age group, who, in the past 20 years, have received treatment for thyroid carcinoma in two centers in Italy (Pisa and Rome). Finally, by molecular biology, genetic mutations of the RET proto-oncogene have been found in several samples of thyroid carcinomas provided by the Belarus

  12. Diagnosis and treatment of Alzheimer's disease

    International Nuclear Information System (INIS)

    Hampel, H.; Padberg, F.; Koetter, H.U.; Teipel, S.J.; Ehrhardt, T.; Hegerl, U.; Stuebner, S.; Moeller, H.J.


    Alzheimer's disease is often diagnosed too late. Its etiology is still largely unknown and remains one of the big challenges in neurobiological fundamental research. Optimized early and differential diagnosis can be ensured by a dynamic concept of multidisciplinary diagnosis in cooperation between practitioners specializing in brain disorders, clinical psychogeriatric deprtments, and general practitioners. This, in turn, will enable individualized planning of further living conditions and care of Alzheimer patients and their relations as well as efficient and early pharmacotherapy and psychological intervention. (orig) [de

  13. Diagnosis, prevention, and management of canine hip dysplasia: a review

    Directory of Open Access Journals (Sweden)

    Schachner ER


    Full Text Available Emma R Schachner, Mandi J Lopez Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA Abstract: Canine hip dysplasia (CHD is a polygenic and multifactorial developmental disorder characterized by coxofemoral (hip joint laxity, degeneration, and osteoarthritis (OA. Current diagnostic techniques are largely subjective measures of joint conformation performed at different stages of development. Recently, measures on three-dimensional images generated from computed tomography scans predicted the development of OA associated with CHD. Continued refinement of similar imaging methods may improve diagnostic imaging techniques to identify dogs predisposed to degenerative hip joint changes. By current consensus, joint changes consistent with CHD are influenced by genetic predisposition as well as environmental and biomechanical factors; however, despite decades of work, the relative contributions of each to the development and extent of CHD signs remain elusive. Similarly, despite considerable effort to decipher the genetic underpinnings of CHD for selective breeding programs, relevant genetic loci remain equivocal. As such, prevention of CHD within domestic canine populations is marginally successful. Conservative management is often employed to manage signs of CHD, with lifelong maintenance of body mass as one of the most promising methods. Surgical intervention is often employed to prevent joint changes or restore joint function, but there are no gold standards for either goal. To date, all CHD phenotypes are considered as a single entity in spite of recognized differences in expression and response to environmental conditions and treatment. Identification of distinct CHD phenotypes and targeting evidence-based conservative and invasive treatments for each may significantly advance prevention and management of a prevalent, debilitating condition in canine companions. Keywords: canine

  14. Generalized anxiety disorder: Differential diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Tatyana Gratsiyevna Voznesenskaya


    Full Text Available Generalized anxiety disorder (GAD is poorly diagnosed and inadequately treated by general practitioners. The paper considers the major diagnostic signs of GAD, its differential diagnosis, prevalence, etiology, and pathogenesis. Antidepressants from a group of selective serotonin reuptake inhibitors in combination with psychotherapy are the drugs of first choice.

  15. Chronic fatigue syndrome: diagnosis and treatment | Revelas ...

    African Journals Online (AJOL)

    Chronic fatigue syndrome (CFS) refers to marked and prolonged fatigue, for which no indentifiable cause can be found. Despite the presence of extensive symptoms, diagnosis is made when there is profound fatigue, lasting for a duration of six months, or longer. CFS is frequently seen in association with psychiatric ...

  16. Diagnosis, injury and prevention of internal radiation exposure

    International Nuclear Information System (INIS)

    Tatsuzaki, Hideo


    Radiation exposure is classified into three categories: external exposure, surface contamination, and internal exposure (also called internal contamination). Internal exposure is an exposure by the ionizing radiation emitted from radioactive materials taken into a human body. Uptake of radioactive materials can go through inhalation, ingestion, or wound contamination. Not like external exposure, alpha ray or beta ray, which has a limited penetration, is also important in internal exposure. Diagnosis of internal exposure is based on measurement and dose assessment in addition to the history taking. Two methods, direct measurement and/or bioassay (indirect measurement), are used for the measurement. These measurements provide information of radioactive materials in the body at the time of the measurement. The exposure dose to the body needs to be calculated in a process of dose assessment, based on the results of these measurements and history of intake, either acute intake or chronic intake. Another method, measurement of environmental samples or food stuff, is also used for dose assessment. For internal exposure, radiation dose to the body is expressed as committed effective dose or committed equivalent dose, which are accumulation of dose over a defined period. Radioactive materials taken into body are transferred among many body components depending on the type of radionuclide or chemicals etc. Some radioactive materials concentrate in a specific organ. Symptoms and signs depend on the distribution of the radioactive materials in the body. Monitoring the concentration in air or foods is conducted in order to control human activities and foods and consequently reduce the amount of intake to human bodies as a preventive measure. Prevention of internal exposure is also conducted by protective gears such as full face masks. Iodine prophylaxis could be used against radioactive iodine intake. Stable iodine, mostly potassium iodide, could be taken into the thyroid and

  17. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. (United States)

    Vivancos, J; Gilo, F; Frutos, R; Maestre, J; García-Pastor, A; Quintana, F; Roda, J M; Ximénez-Carrillo, A; Díez Tejedor, E; Fuentes, B; Alonso de Leciñana, M; Alvarez-Sabin, J; Arenillas, J; Calleja, S; Casado, I; Castellanos, M; Castillo, J; Dávalos, A; Díaz-Otero, F; Egido, J A; Fernández, J C; Freijo, M; Gállego, J; Gil-Núñez, A; Irimia, P; Lago, A; Masjuan, J; Martí-Fábregas, J; Martínez-Sánchez, P; Martínez-Vila, E; Molina, C; Morales, A; Nombela, F; Purroy, F; Ribó, M; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J


    To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  18. Challenges in Diagnosis and Treatment of a Cervical Spinal Cord Injury Patient with Melanoma, Adenocarcinoma, and Hepatic and Osteolytic Metastases: Need to Implement Strategies for Prevention and Early Detection of Cancer in Spinal Cord Injury Patients

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan


    Full Text Available A male tetraplegic patient with, who had been taking warfarin, developed haematuria. Ultrasound scan revealed no masses, stones, or hydronephrosis. Urinary bladder had normal configuration with no evidence of masses or organised haematoma. Urine cytology revealed no malignant cells. Four months later, CT urography revealed an irregular mass at the base of urinary bladder. Cystoscopic biopsy revealed moderately differentiated adenocarcinoma, which contained goblet cells and pools of mucin showing strongly positive immunostaining for prostatic acid hosphatase and patchy staining for prostate specific antigen. Computed Tomography revealed multiple hypodense hepatic lesions and several osteolytic areas in femoral heads and iliac bone. With a presumptive diagnosis of prostatic carcinoma, leuprorelin acetate 3.75 mg was prescribed. This patient expired a month later. Conclusion. (i Spinal cord injury patient, who passed blood in urine while taking warfarin, requires repeated investigations to look for urinary tract neoplasm. (ii Anti-androgen therapy should be prescribed for 2 weeks prior to administration of gonadorelin analogue to prevent tumour flare causing bone pain, bladder outlet obstruction, uraemia, and cardiovascular risk due to hypercoagulability associated with a rapid increase in tumour burden. (iii Spinal cord physicians should adopt a caring and compassionate approach while managing tetraplegic patients with several co-morbidities, as aggressive diagnostic tests and therapeutic procedures may lead to deterioration in the quality of life.

  19. [Medical prevention and treatment of radiation-induced pulmonary complications]. (United States)

    Vallard, A; Rancoule, C; Le Floch, H; Guy, J-B; Espenel, S; Le Péchoux, C; Deutsch, É; Magné, N; Chargari, C


    Radiation-induced lung injuries mainly include the (acute or sub-acute) radiation pneumonitis, the lung fibrosis and the bronchiolitis obliterans organizing pneumonia (BOOP). The present review aims at describing the diagnostic process, the current physiopathological knowledge, and the available (non dosimetric) preventive and curative treatments. Radiation-induced lung injury is a diagnosis of exclusion, since clinical, radiological, or biological pathognomonic evidences do not exist. Investigations should necessarily include a thoracic high resolution CT-scan and lung function tests with a diffusing capacity of the lung for carbon monoxide. No treatment ever really showed efficacy to prevent acute radiation-induced lung injury, or to treat radiation-induced lung fibrosis. The most promising drugs in order to prevent radiation-induced lung injury are amifostine, angiotensin-converting-enzyme inhibitors and pentoxifylline. Inhibitors of collagen synthesis are currently tested at a pre-clinical stage to limit the radiation-induced lung fibrosis. Regarding available treatments of radiation-induced pneumonitis, corticoids can be considered the cornerstone. However, no standardized program or guidelines concerning the initial dose and the gradual tapering have been scientifically established. Alternative treatments can be prescribed, based on clinical cases reporting on the efficacy of immunosuppressive drugs. Such data highlight the major role of the lung dosimetric protection in order to efficiently prevent radiation-induced lung injury. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  20. An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment

    Directory of Open Access Journals (Sweden)

    Lorenzo-Morales Jacob


    Full Text Available Free-living amoebae of the genus Acanthamoeba are causal agents of a severe sight-threatening infection of the cornea known as Acanthamoeba keratitis. Moreover, the number of reported cases worldwide is increasing year after year, mostly in contact lens wearers, although cases have also been reported in non-contact lens wearers. Interestingly, Acanthamoeba keratitis has remained significant, despite our advances in antimicrobial chemotherapy and supportive care. In part, this is due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. In view of the devastating nature of this disease, here we present our current understanding of Acanthamoeba keratitis and molecular mechanisms associated with the disease, as well as virulence traits of Acanthamoeba that may be potential targets for improved diagnosis, therapeutic interventions and/or for the development of preventative measures. Novel molecular approaches such as proteomics, RNAi and a consensus in the diagnostic approaches for a suspected case of Acanthamoeba keratitis are proposed and reviewed based on data which have been compiled after years of working on this amoebic organism using many different techniques and listening to many experts in this field at conferences, workshops and international meetings. Altogether, this review may serve as the milestone for developing an effective solution for the prevention, control and treatment of Acanthamoeba infections.

  1. An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment. (United States)

    Lorenzo-Morales, Jacob; Khan, Naveed A; Walochnik, Julia


    Free-living amoebae of the genus Acanthamoeba are causal agents of a severe sight-threatening infection of the cornea known as Acanthamoeba keratitis. Moreover, the number of reported cases worldwide is increasing year after year, mostly in contact lens wearers, although cases have also been reported in non-contact lens wearers. Interestingly, Acanthamoeba keratitis has remained significant, despite our advances in antimicrobial chemotherapy and supportive care. In part, this is due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. In view of the devastating nature of this disease, here we present our current understanding of Acanthamoeba keratitis and molecular mechanisms associated with the disease, as well as virulence traits of Acanthamoeba that may be potential targets for improved diagnosis, therapeutic interventions and/or for the development of preventative measures. Novel molecular approaches such as proteomics, RNAi and a consensus in the diagnostic approaches for a suspected case of Acanthamoeba keratitis are proposed and reviewed based on data which have been compiled after years of working on this amoebic organism using many different techniques and listening to many experts in this field at conferences, workshops and international meetings. Altogether, this review may serve as the milestone for developing an effective solution for the prevention, control and treatment of Acanthamoeba infections. © J. Lorenzo-Morales et al., published by EDP Sciences, 2015.

  2. An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment (United States)

    Lorenzo-Morales, Jacob; Khan, Naveed A.; Walochnik, Julia


    Free-living amoebae of the genus Acanthamoeba are causal agents of a severe sight-threatening infection of the cornea known as Acanthamoeba keratitis. Moreover, the number of reported cases worldwide is increasing year after year, mostly in contact lens wearers, although cases have also been reported in non-contact lens wearers. Interestingly, Acanthamoeba keratitis has remained significant, despite our advances in antimicrobial chemotherapy and supportive care. In part, this is due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. In view of the devastating nature of this disease, here we present our current understanding of Acanthamoeba keratitis and molecular mechanisms associated with the disease, as well as virulence traits of Acanthamoeba that may be potential targets for improved diagnosis, therapeutic interventions and/or for the development of preventative measures. Novel molecular approaches such as proteomics, RNAi and a consensus in the diagnostic approaches for a suspected case of Acanthamoeba keratitis are proposed and reviewed based on data which have been compiled after years of working on this amoebic organism using many different techniques and listening to many experts in this field at conferences, workshops and international meetings. Altogether, this review may serve as the milestone for developing an effective solution for the prevention, control and treatment of Acanthamoeba infections. PMID:25687209

  3. Attitudes to malaria, prevention, treatment and management ...

    African Journals Online (AJOL)



    Nov 5, 2007 ... to clean environment, and most of times have no means of acquiring better mosquito-bite preventive measures and no access to modern treatment. Some of these conditions may greatly influence their knowledge and attitudes towards handling of malaria episode. Hence, it is the cardinal objective of this ...

  4. [The diagnosis and treatment of fibromyalgia]. (United States)

    Branco, J C


    Fibromyalgia syndrome (FMS) affects predominantly females and is characterised by widespread musculoskeletal pain, fatigue, insomnia, nonrefreshing sleep, diffuse stiffness and other organic and psychic signs and symptoms. Diagnosis is essentially based on the 1990 American College of Rheumatology Classificative Criteria, but if, in some cases, they are not completely fulfilled, diagnosis is not excluded in a particular patient. The causes of the enhanced pain perception and of all the other clinical characteristics are unknown. Both the central hypothesis (sleep disturbance; psychological affection; hypothalamus-hypophysis-adrenal axis disorder; neuromediators disregulation; etc.) and the peripheral theory (anatomical and/or functional muscle disturbance) try to explain FMS etiopathogenesis. Tricycles antidepressants (i.e. amitriptilin) and some muscle relaxants (i.e. ciclobenzaprine) have demonstrated some beneficial effect contrary to the classic antirheumatic drugs (NSAID; corticosteroids; etc.). Physical exercise, multidisciplinary support (behavioural therapy, physical agents; etc.) and patient education are some of the other approaches which contribute to the correct management of FMS.

  5. Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment. (United States)

    Majidi, Shirin; Golembioski, Adam; Wilson, Stephen L; Thompson, Errington C


    Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe pancreatitis is challenging to the clinician. C-reactive protein, pro-calcitonin, and the Bedside Index for Severity of Acute Pancreatitis appeared to be the best tools for the early and accurate diagnosis of severe pancreatitis. Early laparoscopic cholecystectomy is indicated for patients with mild gallstone pancreatitis. For patients who are going to have a prolonged hospitalization, enteral nutrition is preferred. Total parenteral nutrition should be reserved for patients who cannot tolerate enteral nutrition. Prophylactic antibiotics are not indicated for patients with pancreatic necrosis. Surgical intervention for infected pancreatic necrosis should be delayed as long as possible to improve patient outcomes.

  6. Application of nanophotosensitizers (aluminum phthalocyanine nanoparticles) for early diagnosis and prevention of inflammatory diseases (United States)

    Kuznetsova, J. O.; Makarov, V. I.


    This paper deals with a possibility of new types of photosensitizers application - Aluminum Phthalocyanine nanoparticles (nAlPc) in clinical practice for diagnosis, prevention and therapy of inflammatory diseases in dentistry and traumatology. It was detected that the aluminum phthalocyanine (AlPc) fluoresces in the nanoparticle form in the presence of pathologic microflora or inflammation process. It will make possible to detect the local accumulation of pathological microflora on the enamel surface and also for diagnostics and treatment of inflammatory diseases. Experimental studies of interaction of NP-AlPc with tooth enamel and with biological joint tissue at arthrosis are presented.

  7. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment


    Enrico Bellato; Eleonora Marini; Filippo Castoldi; Nicola Barbasetti; Lorenzo Mattei; Davide Edoardo Bonasia; Davide Blonna


    Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable ...

  8. Radiographic caries diagnosis and restorative treatment decision making

    International Nuclear Information System (INIS)

    Mileman, P.A.


    This thesis is concerned with a single diagnostic technique: the bitewing radiograph, and the way it is used by dentists to decide on patient treatment need for interproximal caries. The variation in caries diagnosis and treatment decisions using bitewing radiographs is described and the radiographic criteria of choice for minimizing over and undertreatment according to a norm are investigated. Three possible diagnostic strategies in interproximal caries diagnosis using a decision analysis approach are described and evaluated, and the effect of the reported diagnostic behaviour and knowledge of practicing Dutch dentists in their use of bitewing radiographs for the diagnosis and treatment of interproximal caries is described and analyzed. (Auth.)

  9. Human immunodeficiency virus and tuberculosis coinfection in children: challenges in diagnosis and treatment.

    NARCIS (Netherlands)

    Verhagen, L.M.; Warris, A.; Soolingen, D. van; Groot, R. de; Hermans, P.W.M.


    The burden of childhood tuberculosis (TB) is influenced by the human immunodeficiency virus (HIV) epidemic and this dangerous synergy affects various aspects of both diseases; from pathogenesis and the epidemiologic profile to clinical presentation, diagnosis, treatment, and prevention. HIV-infected

  10. Knowledge and practice on magnitude, diagnosis, treatment and ...

    African Journals Online (AJOL)

    Introduction: In Ethiopia, hepatocellular carcinoma (HCC) is the most common cancer with 100% fatality rate. HCC cases in low income countries die within few months following diagnosis. There is lack of information on the burden, risk factors, diagnosis modalities, surveillance strategies and treatment approaches to HCC ...

  11. Feature: Post Traumatic Stres Disorder PTSD: Symptoms, Diagnosis, Treatment (United States)

    ... Home Current Issue Past Issues Feature PTSD Symptoms, Diagnosis , Treatment Past Issues / Winter 2009 Table of Contents For ... that can help rule out similar conditions. PTSD diagnosis is made based on a certain set of symptoms that begin or ... is yielding new, improved therapies that can ...

  12. Diagnosis and treatment of xerostomia (dry mouth). (United States)

    Napeñas, Joel J; Brennan, Michael T; Fox, Philip C


    Xerostomia (dry mouth) is a common complaint with widespread implications such as impaired quality of life, oral pain, and numerous oral complications. There are a variety of salivary and nonsalivary causes of xerostomia, the most frequent being medication side effects and systemic disorders. A systematic approach should be employed to determine the etiology of this condition, with distinctions made between patients with subjective complaints of xerostomia alone and those with measurable salivary gland dysfunction. Management is multidisciplinary and multimodal. This review summarizes the current literature on the etiology, diagnosis, and complications of xerostomia, and on the management of patients with xerostomia.

  13. Garlic for Cardiovascular Disease: Prevention or Treatment? (United States)

    Alali, Feras Q; El-Elimat, Tamam; Khalid, Lila; Hudaib, Reema; Al-Shehabi, Tuqa Saleh; Eid, Ali H


    Cardiovascular disease (CVD) is the leading cause of global mortality with a substantial economic impact. The annual deaths are expected to increase in the next decade. An array of dietary supplements is being used by people worldwide to ameliorate cardiovascular risk factors. Garlic (Allium sativum L.), a top-selling herbal dietary supplement, is renowned for its wide range beneficial effects, particularly in the treatment and prevention of CVD. This review aims to present a thorough discussion of the available evidence-based data which support the use of garlic in the treatment or prevention of cardiovascular diseases, including atherosclerosis, hypertension, and hyperlipidemia. The molecular mechanisms underlying these effects are dissected as well. This review supports the notion that garlic has the potential to treat mild hypertension, to decrease hypercholesterolemia, and to prevent atherosclerosis. More clinical studies are essential to unequivocally understand the mechanisms underlying treatment or prevention of these cardiovascular conditions. Copyright© Bentham Science Publishers; For any queries, please email at

  14. Guideline for the diagnosis and treatment of scabies in Japan (third edition): Executive Committee of Guideline for the Diagnosis and Treatment of Scabies. (United States)


    In the current work, we present our new guideline for the diagnosis and treatment of scabies which we, the Executive Committee convened by the Japanese Dermatological Association, developed to ensure proper diagnosis and treatment of scabies in Japan. Approval of phenothrin topical use under the National Health Insurance in August 2014 led to this action. Permethrin, a topical anti-scabietic medication belonging to the same pyrethroid group as phenothrin, is already in use worldwide. In this guideline, we introduce criteria for a proper diagnosis of scabies, treatment algorithm for common and crusted (hyperkeratotic) scabies, and prevention. The major change from our second edition is the treatment algorithm. As phenothrin is now available, the first-line therapy for common scabies is either topical phenothrin lotion or oral ivermectin. The second-line option for topical treatment is sulfur-containing ointments, crotamiton cream or benzyl benzoate lotion. γ-Benzene hexachloride ointment is no longer provided for clinical use. In an immunosuppressed patient, the treatment option is still the same, but with close follow up. If the symptoms persist, diagnosis and treatment must be reassessed. For hyperkeratotic scabies and nail scabies, removal of thick crust, cutting of nails and occlusive dressing are additionally required. The safety and effectiveness of combined treatment with topical and oral medications are not yet confirmed. Further assessment is needed. In addition to appropriate treatment, it is essential to educate patients and health-care workers and to conduct epidemiological studies to prevent further spread of the disease through effectively utilizing available resources including manpower, finance, logistics and time. © 2017 Japanese Dermatological Association.

  15. Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Robert F. Pass


    Full Text Available Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection.

  16. Heart Health - Heart Disease: Symptoms, Diagnosis, Treatment (United States)

    ... in Europe. Even though patients receive intense ACS management while in the hospital, new treatments are needed to reduce the risk ... drugs but this treatment is limited to the hospital. NIH Research ... and management of cardiovascular risk factors. Findings will become part ...

  17. Hypothyroidism:Symptoms,Diagnosis and Treatment | NIH Medlineplus the Magazine (United States)

    ... of this page please turn Javascript on. Feature: Hypothyroidism Hypothyroidism: Symptoms, Diagnosis & Treatment Past Issues / Spring 2012 Table ... of its symptoms are seen in other diseases, hypothyroidism usually cannot be diagnosed based on symptoms alone. ...

  18. Nursing diagnosis Noncompliance to treatment in men with hypertension

    Directory of Open Access Journals (Sweden)

    Talliton Uchôa de Araújo


    Full Text Available Objective : to identify the frequency of occurrence of nursing diagnosis Noncompliance of treatment in men with high blood pressure, its defining characteristics, and related factors. Methods : a Cross-sectional study involving 44 men with hypertension by applying a validated instrument for identification of nursing diagnosis. Results : the diagnosis frequency of occurrence was 56.8%, the most present defining characteristics were the inadequate management of nonpharmacological treatment (p=0.000 and adherence failure of indicative behavior (p=0.000. The most common related factors were deficient knowledge for the monitor of the non- drug treatment regimen (p=0.000 and insufficient teaching ability of health staff (p=0.002. Conclusion : it was found a high frequency of diagnosis in men and the data point to the need for training of health professionals for the development of skills in promoting adherence of men to the treatment of hypertension.

  19. Application of nanotechnology in cancers prevention, early detection and treatment. (United States)

    Patel, Shraddha P; Patel, Parshottambhai B; Parekh, Bhavesh B


    Use of nanotechnology in medical science is a rapidly developing area. New opportunities of diagnosis, imaging and therapy have developed due to recent rapid advancement by nanotechnology. The most common areas to be affected are diagnostic, imaging and targeted drug delivery in gastroenterology, oncology, cardiovascular medicine, obstetrics and gynecology. Mass screening with inexpensive imaging might be possible in the near future with the help of nanotechnology. This review paper provides an overview of causes of cancer and the application of nanotechnology in cancer prevention, detection and treatment.

  20. Diagnosis, Treatment and Management of Haemonchus contortus in Small Ruminants. (United States)

    Besier, R B; Kahn, L P; Sargison, N D; Van Wyk, J A


    Haemonchus contortus is a highly pathogenic, blood-feeding nematode of small ruminants, and a significant cause of mortalities worldwide. Haemonchosis is a particularly significant threat in tropical, subtropical and warm temperate regions, where warm and moist conditions favour the free-living stages, but periodic outbreaks occur more widely during periods of transient environmental favourability. The clinical diagnosis of haemonchosis is based mostly on the detection of anaemia in association with a characteristic epidemiological picture, and confirmed at postmortem by the finding of large numbers of H. contortus in the abomasum. The detection of impending haemonchosis relies chiefly on periodic monitoring for anaemia, including through the 'FAMACHA' conjunctival-colour index, or through faecal worm egg counts and other laboratory procedures. A range of anthelmintics for use against H. contortus is available, but in most endemic situations anthelmintic resistance significantly limits the available treatment options. Effective preventative programmes vary depending on environments and enterprise types, and according to the scale of the haemonchosis risk and the local epidemiology of infections, but should aim to prevent disease outbreaks while maintaining anthelmintic efficacy. Appropriate strategies include animal management programmes to avoid excessive H. contortus challenge, genetic and nutritional approaches to enhance resistance and resilience to infection, and the monitoring of H. contortus infection on an individual animal or flock basis. Specific strategies to manage anthelmintic resistance centre on the appropriate use of effective anthelmintics, and refugia-based treatment schedules. Alternative approaches, such as biological control, may also prove useful, and vaccination against H. contortus appears to have significant potential in control programmes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Anorexia nervosa--diagnosis, aetiology, and treatment. (United States)

    Hartman, D


    The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are deliberate weight loss, disturbed body image and amenorrhoea, and complications may include cardiac failure, electrolyte disturbances, hypothermia and osteoporosis. Common clinical findings are described. Disturbed brain serotonin activity is implicated in the aetiology of anorexia nervosa, but there is little support for the use of pharmacological treatments. Psychological theories of aetiology are discussed with reference to Bruch, Crisp, Palazzoli and Minuchin: the common theme is the reaction of the patient and her family to the physical and social changes of puberty. Individual and/or family psychotherapy is seen as central to the treatment of anorexia nervosa, and the relevant clinical research is reviewed. The roles of general practitioners, general psychiatrists and eating disorder specialists are discussed in the light of recent consensus treatment guidelines.

  2. [Diagnosis and treatment of hemolytic anemia]. (United States)

    Kamesaki, Toyomi


    Hemolytic anemia is defined as anemia due to a reduction of the RBC lifespan to less than the normal range of approximately 120 days. Patients with anemia and jaundice are often suspected to have hemolysis. Herein, different causes of hemolysis and the diagnostic algorithm are reviewed. Currently, there is no generic treatment for hemolytic anemia. Appropriate management of a patient with hemolytic anemia requires determination of the underlying cause. Treatments for the different causes of hemolytic anemia are also reviewed.

  3. Diagnosis and treatment of temporomandibular disorders. (United States)

    Gauer, Robert L; Semidey, Michael J


    Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. TMD is classified as intra-articular or extra-articular. Common symptoms include jaw pain or dysfunction, earache, headache, and facial pain. The etiology of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive triggers. Diagnosis is most often based on history and physical examination. Diagnostic imaging may be beneficial when malocclusion or intra-articular abnormalities are suspected. Most patients improve with a combination of noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices. Nonsteroidal anti-inflammatory drugs and muscle relaxants are recommended initially, and benzodiazepines or antidepressants may be added for chronic cases. Referral to an oral and maxillofacial surgeon is indicated for refractory cases.

  4. Diagnosis and treatment of molar incisor hypomineralization. (United States)

    Mathu-Muju, Kavita; Wright, J Timothy


    Molar incisor hypomineralization (MIH) is a relatively common condition that varies in clinical severity and can result in early loss of the permanent 6-year molars. The etiology of MIH remains unclear, and the diagnosis can be confused with more generalized enamel defects such as those that occur in amelogenesis imperfecta. The management of MIH depends largely on the severity of the enamel defect. Degrees of hypomineralization can range from mild enamel opacities to enamel that readily abrades from the tooth as it emerges into the oral cavity. Usually, severely affected molars are extremely hypersensitive, prone to rapid caries development, and can be difficult to manage in young patients. The purpose of this article is to review approaches to diagnosing and treating MIH.

  5. Differential diagnosis and treatment of vestibular vertigo

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov


    Full Text Available Vertigo is a common complaint that leads patients to visit physicians of various specialties. Diseases resulting in vestibular vertigo are very diverse and may be caused by lesion of both the central parts of the vestibular system and the peripheral vestibular apparatus. In many cases, its diagnosis can be made from complaints and a history of disease and special bedside tests requiring no sophisticated equipment. Management of vestibular vertigo should aim at treating the underlying disease; vestibular dilators as symptomatic therapy can be effective for several days. Vestibular exercises the efficiency of which can be enhanced by betahistine and other drugs accelerating vestibular compensation should be further needed. Data on the efficacy of betaver (betahistine in patients with vestibular vertigo are given.

  6. Diagnosis and Treatment of Kaposi Sarcoma. (United States)

    Schneider, Johann W; Dittmer, Dirk P


    Kaposi sarcoma (KS) is the most common neoplasm of people living with HIV today. In Sub-Saharan Africa, KS is among the most common cancers in men, overall. Not only HIV-positive individuals present with KS; any immune compromised person infected with KS-associated herpesvirus (KSHV) or human herpesvirus 8 is at risk: the elderly, children in KSHV-endemic areas, and transplant recipients. KS diagnosis is based on detection of the viral protein latency-associated nuclear antigen (LANA) in the biopsy, but not all cases of KS are the same or will respond to the same therapy. Standard KS therapy has not changed in 20 years, but newer modalities are on the horizon and will be discussed.

  7. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. (United States)

    Rawlinson, William D; Boppana, Suresh B; Fowler, Karen B; Kimberlin, David W; Lazzarotto, Tiziana; Alain, Sophie; Daly, Kate; Doutré, Sara; Gibson, Laura; Giles, Michelle L; Greenlee, Janelle; Hamilton, Stuart T; Harrison, Gail J; Hui, Lisa; Jones, Cheryl A; Palasanthiran, Pamela; Schleiss, Mark R; Shand, Antonia W; van Zuylen, Wendy J


    Congenital cytomegalovirus is the most frequent, yet under-recognised, infectious cause of newborn malformation in developed countries. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. The absence of guidelines impairs global efforts to decrease the effect of congenital cytomegalovirus. Data in the literature suggest that congenital cytomegalovirus infection remains a research priority, but data are yet to be translated into clinical practice. An informal International Congenital Cytomegalovirus Recommendations Group was convened in 2015 to address these questions and to provide recommendations for prevention, diagnosis, and treatment. On the basis of consensus discussions and a review of the literature, we do not support universal screening of mothers and the routine use of cytomegalovirus immunoglobulin for prophylaxis or treatment of infected mothers. However, treatment guidelines for infected neonates were recommended. Consideration must be given to universal neonatal screening for cytomegalovirus to facilitate early detection and intervention for sensorineural hearing loss and developmental delay, where appropriate. The group agreed that education and prevention strategies for mothers were beneficial, and that recommendations will need continual updating as further data become available. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Intermittent preventive treatment of malaria in pregnancy

    DEFF Research Database (Denmark)

    Mbonye, A.K.; Bygbjerg, Ib Christian; Magnussen, Pascal


    OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. METHODS: A non-randomized comm......OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. METHODS: A non......, still births, and maternal and child deaths were secondary endpoints. FINDINGS: 1404 (67.5%) of 2081 with the new delivery system received two doses of sulfadoxine-pyrimethamine versus 281 (39.9%) of 704 with health units (P

  9. Fibromyalgia syndrome: classification, diagnosis, and treatment. (United States)

    Häuser, Winfried; Eich, Wolfgang; Herrmann, Markus; Nutzinger, Detlev O; Schiltenwolf, Marcus; Henningsen, Peter


    This S3 guideline takes positions on currently contentious issues in the classification and treatment of fibromyalgia syndrome (FMS). A panel of experts from 10 specialist societies and patients belonging to 2 patient self-help organizations reviewed a total of approximately 8000 publications. Recommendations were developed according to the suggested procedure for S3 guidelines and were then reviewed and approved by the boards of the participating specialist societies. The steering committee ensured that the literature review and the recommendations were kept up to date. Because this disorder is defined by its symptoms and signs, rather than by any consistently identifiable bodily lesion, the term "fibromyalgia syndrome" is a more appropriate designation for it than "fibromyalgia." FMS is defined by the criteria of the American College of Rheumatology and is classified as a functional somatic syndrome. FMS is diagnosed from the typical constellation of symptoms and by the exclusion of inflammatory and metabolic diseases that could cause the same symptoms. A stepwise treatment approach in which the patient and the physician decide jointly on the treatment options is recommended. The most strongly recommended forms of treatment are aerobic exercise, amitriptyline, cognitive behavioral therapy, and spa therapy. The guideline recommendations are intended to promote more effective treatment of this disorder.

  10. Outcomes of a Cross-Disciplinary Concussion Prevention and Diagnosis Workshop Series

    Directory of Open Access Journals (Sweden)

    Patrick Drane


    Full Text Available This paper reports the outcomes of a series of two Concussion Research Workshops held in Lowell, MA, USA. The workshop examined the state-of-the-art in concussion research, research challenges and the future directions of research within the following three core topic areas: (A Concussion Prevention Techniques & Technology, (B Concussion Diagnosis, and (C Treatment of Concussions. Concussions are a form of traumatic brain injury caused by an impact and are a growing concern among athletes and those who are involved with sports. Recent years have led to increasing awareness and research related to concussions with limited definitive understanding of the specific mechanism and pathology. Technology is beginning to take on an important role in the prevention, diagnosis and treatment of concussions. Currently, sensors provide data about the impact and the athlete. However, sensors and better protective equipment can enable an effective monitoring and thus protection of athletes. Only when a more definitive understanding of the injury mechanism is achieved, can sensors and protective equipment design contribute to effective monitoring and protection of athletes.

  11. Dual diagnosis in Depression: treatment recommendations. (United States)

    Tirado Muñoz, Judit; Farré, Adriana; Mestre-Pintó, Joan; Szerman, Nestor; Torrens, Marta


    Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately.

  12. Diagnosis and treatment of pathologic gambling. (United States)

    Sood, Erica D; Pallanti, Stefano; Hollander, Eric


    Pathologic gambling (PG) is an impulse control disorder characterized by recurrent and maladaptive gambling behaviors that significantly disrupt the patient's functioning in the personal, familial, or vocational spheres. Pathologic gambling is estimated to currently affect 1% to 3.4% of the adult US population and is frequently comorbid with substance abuse or dependence, attention-deficit/hyperactivity disorder (ADHD), and affective disorders. Studies show evidence for the involvement of the serotonergic, noradrenergic, and dopaminergic systems in the etiology of PG. Medication treatment studies performed in PG patients demonstrated the short-term efficacy of various serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers in a subsample of adult pathologic gamblers who seek treatment. This review focuses on recent research examining the neurobiology and treatment of PG.

  13. Mozart ear: diagnosis, treatment, and literature review. (United States)

    Yamashita, Ken; Yotsuyanagi, Takatoshi; Saito, Tamotsu; Isogai, Noritaka; Mori, Hiromasa; Itani, Yoshihito


    Mozart ear is a congenital auricular deformity, which is mainly characterized by a bulging appearance of the anterosuperior portion of the auricle, a convexly protruded cavum conchae, and a slit-like narrowing of the orifice of the external auditory meatus. It is said to be uncommon, and because no one has yet fully described neither the disease nor the treatment, the concept of Mozart ear has not been unified. This report describes a case of a 13-year-old girl presented with an unusual congenital deformity which showed the features of Mozart ear. It is an extremely rare deformity that only about 4 clinical cases have been reported in medical literature thereby a treatment method has not been fully discussed. For surgical correction of our cases, we excised deformed conchal cartilage, turned it over, regrafted, and maintained a cosmetically positive result. We also reviewed and described the origin, current concept, and treatment method of Mozart ear.

  14. [Chinese expert consensus on the diagnosis and treatment of hypertension in the elderly(2017)]. (United States)


    China has stepped into an aging society. Hypertension is an independent risk factor of cardio-cerebrovascular diseases and related to mortality and disability of the elderly. Compared to middle-aged and young patients with similar blood pressure elevation, the risks of cardiovascular and cerebrovascular events significantly increase in the elderly. Since the Chinese expert consensus on the diagnosis and treatment of hypertension in the elderly(2008, 2011 version) were published, many guidelines have been accordingly updated, which further improved the prevention and control strategy of hypertension. In this article, Chinese expert consensus on the diagnosis and treatment of hypertension in the elderly(2017) is revised as to facilitate the prevention and treatment of hypertension in Chinese elderly. The consensus is composed of eight parts, including definition, epidemiology, characteristics, evidence, treatment objectives and measurements of elderly hypertension. The purpose of the consensus is to provide guidance for management of elderly hypertensive patients.

  15. Malabsorption: causes, consequences, diagnosis and treatment ...

    African Journals Online (AJOL)

    Malabsorption generally refers to the alterations of the gastrointestinal tract affecting the digestion, absorption and transport of nutrients across the bowel wall. In this article the causes, diagnostic tests and appropriate treatment options will be discussed by differentiating between premucosal, mucosal and postmucosal ...

  16. Ambiguous diagnosis, futile treatments and temporary recovery ...

    African Journals Online (AJOL)

    The objective of the article is to explore caregivers' experiences with diagnostic procedures and outcomes, prescriptions and treatment outcomes when ARVs were unavailable. A phenomenological design using in-depth face-to-face interviews was used to obtain the experiences of 21 family caregivers about caregiving, ...

  17. [Diagnosis and treatment of respiratory tract burns]. (United States)

    Gerasimova, L I; Loginov, L P; Smol'skii, B G; Pelikh, S T; Skripal', A Iu


    The work gives an analysis of clinical signs in 111 patients with burns of the respiratory tract. Two complexes of curative measures are proposed according to anatomical changes found in fibrobronchoscopy. The fibrobronchoscopies are of special importance in the treatment of burns of the tracheobronchial tree.

  18. Greater trochanteric pain syndrome diagnosis and treatment. (United States)

    Mallow, Michael; Nazarian, Levon N


    Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Diagnosis and treatment of Ewing's sarcoma

    International Nuclear Information System (INIS)

    Iwamoto, Yukihide


    Ewing's sarcoma is a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents. Ewing's sarcoma has retained the most unfavorable prognosis of all primary musculoskeletal tumors. Prior to the use of multi-drug chemotherapy, long-term survival was less than 10%. The development of multi-disciplinary therapy with chemotherapy, irradiation, and surgery has increased current long-term survival rates in most clinical centers to greater than 50%. In addition, the preferred method of tumor resection has changed; limb salvage has nearly replaced amputation of the affected limb. Limb salvage procedures can be performed in place of amputation without compromising patient survival rates. Recent studies have revealed that the pathognomonic translocations involving the EWS gene on chromosome 22 and an ETS-type gene, which is most commonly the Fli1 gene on chromosome 11, are implicated in more than 95% of Ewing's sarcomas, primitive neuroectodermal tumors and Askin's tumors. Therefore, these lesions have become regarded as a single entity, dubbed the Ewing's family of tumors. Reverse transcription polymerase chain reaction (RT-PCR) to detect EWS-ETS gene arrangements is widely used to confirm the diagnosis of Ewing's family of tumors. Experimental results suggest that inhibition of the signaling pathway downstream of the EWS-ETS gene may lead to the development of molecularly targeted therapy in the future. (author)

  20. Lyme Borreliosis: Diagnosis and Treatment Issues

    Directory of Open Access Journals (Sweden)

    L.R. Shostakovych-Koretska


    Full Text Available Lyme borreliosis (LB — the most common natural focal transmissible infection which occur in the USA, Europe, including Ukraine. It is a multisystem disease affecting the skin, heart, nervous system, joints that are prone to prolonged course. Official registration of the disease in Ukraine is being carried out since 2000. Level of epidemiological registration increases every year: LB incidence in Ukraine since 2000 for 10 years has increased 29 times, in the Dnipropetrovsk region — 12 times. The disease goes through several stages: from the appearance of the primary form — erythema migrans to the formation of chronic forms, which can lead to disability. In 25–50 % of patients, in the absence of adequate antibiotic therapy, in the early LB period we defined chronic form of the disease, especially heart failure. In this paper we present an algorithm for early diagnosis of «minor», clinically silent forms of heart disorders in LB at the early stages of the disease with the aim of rational choice of antibiotic therapy. It is shown that serological markers of LB (antibodies to IgM and IgG Borrelias can not be used to monitor the effectiveness of therapy.

  1. Probiotics for prevention and treatment of diarrhea. (United States)

    Guandalini, Stefano


    Probiotics have been extensively studied over the past several years in the prevention and, to a larger extent, in the treatment of diarrheal diseases, especially in pediatric populations. Diarrhea is a symptom, and not a disease. This review will not address chronic disorders associated with diarrhea, or Clostridium difficile-induced diarrhea. Rather it will focus on published clinical trials performed on acute-onset, likely infectious diarrhea occurring in the settings of day-care centers, in the community, acquired in the hospital, antibiotic-associated diarrhea, and treatment of acute infectious diarrhea. For prevention of diarrhea acquired in day-care centers, 9 randomized and placebo-controlled trials have been published, conducted in different parts of the world. Probiotics tested were Lactobacillus GG, Bifidobacterium lactis (alone or in combination with Streptococcus thermophilus, and Lactobacillus reuteri, Lactobacillus rhamnosus (not GG), and Lactobacillus acidophilus, in various trials either alone or in comparison with each other. The evidence of their efficacy in these settings is only modest for the prevention of diarrhea, although somewhat better for prevention of upper respiratory infections. In the community, new trails conducted in underprivileged areas of India, again with modest efficacy. Previous trials that examined the potential role of probiotics in preventing the spreading of diarrhea in hospitalized children had yielded conflicting results. More recently, a large trial in Poland showed, however, rather good evidence of efficacy for Lactobacillus GG. The prevention of antibiotic-associated diarrhea has been the subject of many investigations, both in children and in adults. Most commonly used probiotics were Lactobacillus GG, Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium ssp, Streptococcus ssp, and the yeast Saccharomyces boulardii. In general, most of these trials do show clear evidence of efficacy, with the 2 most

  2. Lumbar supports for prevention and treatment of low back pain

    NARCIS (Netherlands)

    van Duijvenbode, I. C. D.; Jellema, P.; van Poppel, M. N. M.; van Tulder, M. W.


    Lumbar supports are used in the treatment of low-back pain patients, to prevent the onset of low-back pain (primary prevention) or to prevent recurrences of a low-back pain episode (secondary prevention). To assess the effects of lumbar supports for prevention and treatment of non-specific low-back

  3. Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment (United States)

    Serhiyenko, Victoria A; Serhiyenko, Alexandr A


    Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus (DM) that is strongly associated with approximately five-fold increased risk of cardiovascular mortality. CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heart rate (HR) to development of “silent” myocardial infarction. Clinical correlates or risk markers for CAN are age, DM duration, glycemic control, hypertension, and dyslipidemia (DLP), development of other microvascular complications. Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension, DLP, obesity, and unsatisfactory glycemic control in type 2 DM. Symptomatic manifestations of CAN include sinus tachycardia, exercise intolerance, orthostatic hypotension (OH), abnormal blood pressure (BP) regulation, dizziness, presyncope and syncope, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction. Methods of CAN assessment in clinical practice include assessment of symptoms and signs, cardiovascular reflex tests based on HR and BP, short-term electrocardiography (ECG), QT interval prolongation, HR variability (24 h, classic 24 h Holter ECG), ambulatory BP monitoring, HR turbulence, baroreflex sensitivity, muscle sympathetic nerve activity, catecholamine assessment and cardiovascular sympathetic tests, heart sympathetic imaging. Although it is common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Pathogenetic treatment of CAN includes: Balanced diet and physical activity; optimization of glycemic control; treatment of DLP; antioxidants, first of all α-lipoic acid (ALA), aldose reductase inhibitors, acetyl-L-carnitine; vitamins, first of all fat-soluble vitamin B1; correction of vascular endothelial

  4. Role of laparoscopy in diagnosis and treatment of ectopic pregnancy. (United States)

    Shrestha, J; Saha, R


    Laparoscopy has a great role in early and effective diagnosis and treatment of ectopic pregnancy. This study was carried out to evaluate the feasibility and role of laparoscopy in diagnosis and treatment of ectopic pregnancy. This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital from April 2009 to March 2011. All the women who underwent laparoscopy for ectopic pregnancy or diagnosed as ectopic pregnancy during laparoscopy done for other diagnosis were included. Data were collected by interviewing patients, operating surgeons, reviewing charts and operative notes and following up patients. There were 42 cases of ectopic pregnancy during study period, of whom 16 (38.1%) underwent laparoscopy. Preoperative diagnosis of ectopic pregnancy was confirmed clinically in 6 (37.5%) patients, who underwent laparoscopy as an operative procedure. In the remaining 6 (37.5%), laparoscopy was performed as a diagnostic procedure as clinical diagnosis was doubtful; two cases of negative laparoscopy was noted. Incidental diagnosis of ectopic pregnancy was made in another 4 (25%) patients who had undergone laparoscopy for other pre operative diagnosis. All the patients were surgically managed by laparoscopy without converting it to laparotomy. There were no intraoperative or postoperative complications except for primary port infection in few (25%). Therefore, laparoscopy has a significant role in the diagnosis of ectopic pregnancy and operative laparoscopy is a safe approach with minimal complications.

  5. Diagnóstico, tratamento e prevenção da mania e da hipomania no transtorno bipolar Diagnosis, treatment and prevention of mania and hipomania within the bipolar disorder

    Directory of Open Access Journals (Sweden)

    Ricardo Alberto Moreno


    Full Text Available Pelo menos 5% (Moreno, 2004 e Angst et al., 2003 da população geral já apresentou mania ou hipomania. A irritabilidade e sintomas depressivos durante episódios de hiperatividade breves e a heterogeneidade de sintomas complicam o diagnóstico. Doenças neurológicas, endócrinas, metabólicas e inflamatórias podem causar uma síndrome maníaca. Às vezes, a hipomania ou a mania são diagnosticadas de forma errada como normalidade, depressão maior, esquizofrenia ou transtornos de personalidade, ansiosos ou de controle de impulsos. O lítio é a primeira escolha no tratamento da mania, mas ácido valpróico, carbamazepina e antipsicóticos atípicos são também freqüentemente utilizados. A eletroconvulsoterapia está indicada na mania grave, psicótica ou gestacional. A maioria dos estudos controlados para a profilaxia de episódios maníacos foi realizada com lítio e mais estudos são necessários para investigar a eficácia profilática do valproato, da olanzapina e de outras medicações. O tratamento e a profilaxia da hipomania foram pouco estudados e, de modo geral, seguem as mesmas diretrizes usadas para a mania.At least 5% (Moreno, 2004 e Angst et al., 2003 of the general population have presented mania or hypomania. Irritability and depressive symptoms during brief hyperactivity episodes and the heterogeneity of symptoms complicate the diagnosis. Neurological, metabolic, endocrine, inflammatory diseases, besides drugs intoxication and abstinence can cause a manic syndrome. Sometimes hypomania or mania are misdiagnosed as normality, major depression, schizophrenia, personality, anxiety and impulse control disorders. Lithium is the first treatment choice for episodes of mania. Valproic acid, carbamazepine and atypical antipsychotics are frequently used as well. Electroconvulsive therapy should be used in severe, psychotic or gestational mania. For the prophylaxy of manic episodes, lithium is the medication with most controlled

  6. Current Diagnosis and Treatment of Anxiety Disorders


    Bystritsky, Alexander; Khalsa, Sahib S.; Cameron, Michael E.; Schiffman, Jason


    Anxiety disorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxiety disorders are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). However, each of t...

  7. Medial Patella Subluxation: Diagnosis and Treatment


    McCarthy, Mark A.; Bollier, Mathew J.


    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and pa...

  8. Chiari malformations: diagnosis, treatments and failures. (United States)

    Abd-El-Barr, M M; Strong, C I; Groff, M W


    Chiari malformations refer to abnormalities of the hindbrain originally described by the Austrian pathologist Hans Chiari in the early 1890s. These malformations range from herniation of the cerebellar tonsils through the foramen magnum to complete agenesis of the cerebellum. In this review, we review the different classification schemes of Chiari malformations. We discuss the different signs and symptoms that the two most common malformations present with and diagnostic criteria. We next discuss current treatment paradigms, including the new measure of possible in utero surgery to help decrease the incidence of Chiari type II malformations. There is also a small discussion of treatment failures and salvage procedures in these difficult cases. Chiari malformations are a difficult clinical entity to treat. As more is learned about the genetic and environmental factors relating to their characteristics, it will be interesting if we are able to predict which treatments are better suited for different patients. Similarly, with the evolution of in utero techniques especially for Chiari II malformations, it will be interesting to see if the incidence and practice of treating these difficult patients will change.

  9. [Scleritis and episcleritis: diagnosis and treatment]. (United States)

    Héron, E; Gutzwiller-Fontaine, M; Bourcier, T


    Episcleritis and scleritis are distinct entities with regard to visual prognosis, risk of associated systemic disease, and treatment. The pertinence of the clinical classification of episcleritis and scleritis established in 1976 still persists, with significant differences in terms of visual prognosis, associated general conditions, and therapeutic choices according to each scleritis subtype. Episcleritis requires rarely to be referred to a tertiary care centre, and if so it has to be monitored similarly to scleritis. In this paper, an analysis of 1358 scleritis cases from the main distinct large series published since 1976 shows a mean proportion of 8% of infectious aetiologies (mainly herpes viruses), and 28% of systemic diseases with two main subgroups: inflammatory rheumatisms 12.8%, and systemic vasculitis 7.8%. Overall, the risk for visual loss following scleritis is around 16%. However, the risks of associated systemic disease and visual loss are both highly variable according to the type of scleritis, and culminate at 80% and 50% in the necrotizing subtype respectively. As compared with older series, the proportion of necrotizing scleritis is lower in recent series which is likely due to the advances obtained over the past 20 years in immunomodulatory therapy, as well as its wide use in the treatment of the main systemic conditions associated with scleritis. The treatment of scleritis should be managed by physicians who are experts in the use of immunosuppressive drugs that may be required in one out of two affected patients. Copyright © 2014. Published by Elsevier SAS.

  10. Fournier gangrene. Approaches to diagnosis and treatment. (United States)

    Unal, Bulent; Kocer, Belma; Ozel, Ebru; Bozkurt, Betul; Yildirim, Osman; Altun, Buket; Dolapci, Mete; Cengiz, Omer


    To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus (DM) as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene. Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively. The mean age of the patients was 52.8 years. There were 8 female (30.8%) and 18 male (69.2%) patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus (DM) and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients. In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene.

  11. Pelvic inflammatory disease in the adolescent: understanding diagnosis and treatment as a health care provider. (United States)

    Woods, Jennifer L; Scurlock, Amy M; Hensel, Devon J


    Pelvic inflammatory disease (PID) is a common clinical syndrome with highest rates in adolescents, but no studies have singularly focused on this population in relationship to established guidelines for diagnosis and treatment. The study objective was to assess knowledge of diagnosis and treatment criteria for PID within an adolescent population and to compare factors associated with adherence to Centers for Disease Control and Prevention guidelines in outpatient settings. Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of sexually transmitted infections in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12 to 21 years of age and were given an International Classification of Diseases, Ninth Revision/chart diagnosis of PID. Two primary outcome variables were utilized: meeting PID diagnosis guidelines (no/yes) and correct treatment for subject meeting criteria with guidelines (no/yes). The study controlled for race, age, medical venue, and current/past infection with gonorrhea/chlamydia. Subjects (n = 150) were examined for the primary outcome variables; 78% (117/150) met at least 1 criterion for PID diagnosis. Nearly 75% (111/150) had cervical motion tenderness, 34% (51/150) adnexal tenderness, and 5% (7/150) had uterine tenderness; nearly 11% (16/150) were positive for all 3 criteria. Symptoms associated with PID were compared for subjects meeting diagnosis criteria versus subjects not meeting diagnosis criteria: abdominal pain and vomiting were significantly associated with PID diagnosis at P Pelvic inflammatory disease and cervicitis appear to be confused by providers in the diagnosis process, and educational tools may be necessary to increase the knowledge base of practitioners in regard to PID.

  12. [Diagnosis and treatment of thoracic injuries]. (United States)

    Guguli, M; Gasi, M


    Injuries of the chest isolated or joined with injuries of other organs are distinctly increasing. There are almost no polytraumatic people without thorax injuries. Traffic traumas have a dominant role in causing these injuries. We had most injuries in sammer months. The isolated chest injurie we had 60% and the accompanying injurie 40%. Of the accompanying injuries, the head injurie have the most autstanding place, which especially make difficult the diagnostics, and curing. In heavy injuries of the thorax with paradoxical breathing and on both sides of the leasions, establishing the internal pneumatic stabilisation at the beginning by pulmomatic and then ostheosyntesis of ribs are the most effective therapy. In order to prevent the infections, atracheobronchial dressing with antibiotics is performed as well as the regular X-ray check. As a general rule than 200 ml. per 3 hour requires operative control of the hemorrhage. We had 5,6% thoracothomy after continuous drainage by persstend hemorrhage. The obstructive pneumonia, particularly the eldery are to avoid obstructis, aspiration by catheter with bronchoscopy.

  13. Cracked tooth diagnosis and treatment: An alternative paradigm. (United States)

    Mamoun, John S; Napoletano, Donato


    This article reviews the diagnosis and treatment of cracked teeth, and explores common clinical examples of cracked teeth, such as cusp fractures, fractures into tooth furcations, and root fractures. This article provides alternative definitions of terms such as cracked teeth, complete and incomplete fractures and crack lines, and explores the scientific rationale for dental terminology commonly used to describe cracked teeth, such as cracked tooth syndrome, structural versus nonstructural cracks, and vertical, horizontal, and oblique fractures. The article explains the advantages of high magnification loupes (×6-8 or greater), or the surgical operating microscope, combined with co-axial or head-mounted illumination, when observing teeth for microscopic crack lines or enamel craze lines. The article explores what biomechanical factors help to facilitate the development of cracks in teeth, and under what circumstances a full coverage crown may be indicated for preventing further propagation of a fracture plane. Articles on cracked tooth phenomena were located via a PubMed search using a variety of keywords, and via selective hand-searching of citations contained within located articles.

  14. Cracked tooth diagnosis and treatment: An alternative paradigm (United States)

    Mamoun, John S.; Napoletano, Donato


    This article reviews the diagnosis and treatment of cracked teeth, and explores common clinical examples of cracked teeth, such as cusp fractures, fractures into tooth furcations, and root fractures. This article provides alternative definitions of terms such as cracked teeth, complete and incomplete fractures and crack lines, and explores the scientific rationale for dental terminology commonly used to describe cracked teeth, such as cracked tooth syndrome, structural versus nonstructural cracks, and vertical, horizontal, and oblique fractures. The article explains the advantages of high magnification loupes (×6–8 or greater), or the surgical operating microscope, combined with co-axial or head-mounted illumination, when observing teeth for microscopic crack lines or enamel craze lines. The article explores what biomechanical factors help to facilitate the development of cracks in teeth, and under what circumstances a full coverage crown may be indicated for preventing further propagation of a fracture plane. Articles on cracked tooth phenomena were located via a PubMed search using a variety of keywords, and via selective hand-searching of citations contained within located articles. PMID:26038667

  15. Acute recurrent pancreatitis: Etiopathogenesis, diagnosis and treatment (United States)

    Testoni, Pier Alberto


    Acute recurrent pancreatitis (ARP) refers to a clinical entity characterized by episodes of acute pancreatitis which occurs on more than one occasion. Recurrence of pancreatitis generally occurs in a setting of normal morpho-functional gland, however, an established chronic disease may be found either on the occasion of the first episode of pancreatitis or during the follow-up. The aetiology of ARP can be identified in the majority of patients. Most common causes include common bile duct stones or sludge and bile crystals; sphincter of oddi dysfunction; anatomical ductal variants interfering with pancreatic juice outflow; obstruction of the main pancreatic duct or pancreatico-biliary junction; genetic mutations; alcohol consumption. However, despite diagnostic technologies, the aetiology of ARP still remains unknown in up to 30% of cases: in these cases the term “idiopathic” is used. Because occult bile stone disease and sphincter of oddi dysfunction account for the majority of cases, cholecystectomy, and eventually the endoscopic biliary and/or pancreatic sphincterotomy are curative in most of cases. Endoscopic biliary sphincterotomy appeared to be a curative procedure per se in about 80% of patients. Ursodeoxycholic acid oral treatment alone has also been reported effective for treatment of biliary sludge. In uncertain cases toxin botulin injection may help in identifying some sphincter of oddi dysfunction, but this treatment is not widely used. In the last twenty years, pancreatic endotherapy has been proven effective in cases of recurrent pancreatitis depending on pancreatic ductal obstruction, independently from the cause of obstruction, and has been widely used instead of more aggressive approaches. PMID:25493002

  16. Diagnosis and treatment of an excess vertical dimension malocclusion

    Directory of Open Access Journals (Sweden)

    Vaden JL


    Full Text Available The orthodontic clinician must use a careful differential diagnosis protocol for each patient who seeks his or her care. The diagnosis must analyze all three components of a malocclusion—facial, dental, and skeletal. Each component must be carefully studied and understood so that (1 the proper questions are asked and (2 the correct diagnostic decisions are made so that an effective treatment plan can be developed. Once the treatment plan is finalized, proper forces at appropriate treatment intervals must be utilized. If these concepts are used, most vertically compromised patients can be successfully treated with conventional orthodontics.

  17. Cheating and sports: history, diagnosis and treatment. (United States)

    Kamis, Danielle; Newmark, Thomas; Begel, Daniel; Glick, Ira D


    This paper focuses on "cheating" in modern day athletics from youth through professional sports. We briefly summarize a history of cheating in the sports world. We examine the current role cheating plays in sports as well as its causes including, psychodynamic issues, the development of personality disorders and how personality traits become pathological resulting in deception, dishonesty, and underhandedness. We describe management and treatment including psychotherapeutic intervention as well as medication. Finally we discuss a systems approach involving outreach to coaches, families, and related sports organizations (like FIFA, WADA, etc) or the professional leagues which have institutional control and partial influence on the athlete.

  18. Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment (United States)

    Choate, Laura H.; Gintner, Gary G.


    The purpose of this article is to provide counselors with an overview of best practices for the treatment of women who experience prenatal depression (PND). The authors first discuss issues in the screening and diagnosis of PND. Next, the 2 most common treatments, antidepressants and psychotherapy, are reviewed and discussed in relation to current…

  19. Ciguatera Fish Poisoning: Treatment, Prevention and Management

    Directory of Open Access Journals (Sweden)

    Andrew Reich


    Full Text Available Ciguatera Fish Poisoning (CFP is the most frequently reported seafood-toxin illness in the world, and it causes substantial physical and functional impact. It produces a myriad of gastrointestinal, neurologic and/or cardiovascular symptoms which last days to weeks, or even months. Although there are reports of symptom amelioration with some interventions (e.g. IV mannitol, the appropriate treatment for CFP remains unclear to many physicians. We review the literature on the treatments for CFP, including randomized controlled studies and anecdotal reports. The article is intended to clarify treatment options, and provide information about management and prevention of CFP, for emergency room physicians, poison control information providers, other health care providers, and patients.

  20. Ciguatera Fish Poisoning: Treatment, Prevention and Management (United States)

    Friedman, Melissa A.; Fleming, Lora E.; Fernandez, Mercedes; Bienfang, Paul; Schrank, Kathleen; Dickey, Robert; Bottein, Marie-Yasmine; Backer, Lorraine; Ayyar, Ram; Weisman, Richard; Watkins, Sharon; Granade, Ray; Reich, Andrew


    Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world, and it causes substantial physical and functional impact. It produces a myriad of gastrointestinal, neurologic and/or cardiovascular symptoms which last days to weeks, or even months. Although there are reports of symptom amelioration with some interventions (e.g. IV mannitol), the appropriate treatment for CFP remains unclear to many physicians. We review the literature on the treatments for CFP, including randomized controlled studies and anecdotal reports. The article is intended to clarify treatment options, and provide information about management and prevention of CFP, for emergency room physicians, poison control information providers, other health care providers, and patients. PMID:19005579

  1. Nonpharmacologic treatment and prevention strategies for dementia. (United States)

    Yaffe, Kristine; Hoang, Tina


    Epidemiologic studies can provide critical evidence to inform the timing and duration of nonpharmacologic interventions. Although more studies are needed to further determine long-term efficacy, the evidence supporting modifiable risk factors for prevention is compelling, and prevention strategies that incorporate multidomain nonpharmacologic factors may have the most impact. Epidemiologic studies have identified a number of promising nonpharmacologic factors that have the potential to lower the risk of developing dementia. Potential modifiable strategies for dementia prevention include cardiovascular risk factors; lifestyle risk factors such as physical, cognitive, and social activity as well as nutrition, smoking, and alcohol use; and sleep quality. Results of randomized controlled trials for the treatment of cardiovascular risk factors have not been consistent, while interventions that increase physical, cognitive, and social activity have demonstrated protective effects for dementia risk. Trials of single-nutrient dietary supplementation have also been conflicting, but focus on multinutrient supplementation shows promise. Observational data also indicate that sleep quality may be a modifiable risk factor for dementia prevention.

  2. Hemoglobinopathies: clinical manifestations, diagnosis, and treatment. (United States)

    Kohne, Elisabeth


    Hemoglobinopathies are among the most common inherited diseases around the world. They have become much more common recently in northern and central Europe, including Germany, due to immigration. Selective review of the literature with consideration of national guidelines. The hemoglobinopathies encompass all genetic diseases of hemoglobin. They fall into two main groups: thalassemia syndromes and structural hemoglobin variants (abnormal hemoglobins). α- and β-thalassemia are the main types of thalassemia; the main structural hemoglobin variants are HbS, HbE and HbC. There are many subtypes and combined types in each group. The highly variable clinical manifestations of the hemoglobinopathies range from mild hypochromic anemia to moderate hematological disease to severe, lifelong, transfusion-dependent anemia with multiorgan involvement. Stem-cell transplantation is the preferred treatment for the severe forms of thalassemia. Supportive, rather than curative, treatment consists of periodic blood transfusions for life, combined with iron chelation. Drugs to treat the symptoms of sickle-cell disease include analgesics, antibiotics, ACE inhibitors and hydroxyurea. Blood transfusions should be given only when strictly indicated. More than 90% of patients currently survive into adulthood. Optimally treated patients have a projected life span of 50 to 60 years. Hemoglobinopathies are a public health issue in today's multiethnic German population. Adequate care of the affected patients requires a wide variety of diagnostic and therapeutic measures.

  3. Diagnosis and treatment of pyogenic bone infections. (United States)

    Ikpeme, I A; Ngim, N E; Ikpeme, A A


    Pyogenic osteomyelitis is still frequently seen in the developing world and the treatment of chronic osteomyelitis presents a considerable challenge despite advances in microbiological techniques, antibiotics and surgical techniques. Acute haematogenous osteomyelitis is commoner in children. In the pre-antibiotic era, mortality rate was high and progression to chronic osteomyelitis was common. A near similar scenario still exists in many developing countries due to the combination of inappropriate and/or inadequate antibiotic therapy, delayed presentation and unorthodox interventions by traditional healers. Chronic osteomyelitis may result from poorly treated or untreated acute osteomyelitis, open fractures, surgery for an array of orthopaedic conditions and from contiguous spread from infected soft tissue as may occur in diabetic foot infections. A large array of treatment techniques hinged on sequestrectomy/ debridement, management of dead space, improvement of oxygenation and perfusion to ischaemic tissue exist. Despite these, total eradication of disease is difficult. This article summarizes the pathology and methods of management available for pyogenic osteomyelitis. In its acute and chronic forms, the disease is likely to remain prevalent in the developing world until issues of ignorance, poverty and prompt access to appropriate and efficacious medical care are addressed.

  4. Female sexual disorders: assessment, diagnosis, and treatment. (United States)

    Kingsberg, Sheryl A; Knudson, Gail


    Sexual health is important to overall health and quality of life. Sexual problems have been associated with relationship problems and may interfere with overall health and they may also be a marker for other undiagnosed comorbid medical conditions. In order for healthcare professionals to manage the sexual health concerns of their patients, it is important for them to understand what constitutes good sexual health. To that end, it is necessary to have a working knowledge of the evolving theoretical models offered to describe a healthy sexual response as well as an understanding of the neurobiology of sexual function. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised lists six primary female sexual disorders: hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, female orgasmic disorder,dyspareunia, and vaginismus. Despite a growing awareness of the high prevalence of sexual disorders they are not typically identified nor treated. There are a number of reasons why clinicians fail to identify and treat sexual problems including insufficient training in sexual medicine and communication skills, time-constraints, and embarrassment. Treatment for female sexual problems is usually individualized and may include a combination of office-based education and basic counseling, cognitive-behavioral psychotherapy, pharmacotherapy, and treatment of concomitant medical conditions.

  5. Computer modeling of lung cancer diagnosis-to-treatment process. (United States)

    Ju, Feng; Lee, Hyo Kyung; Osarogiagbon, Raymond U; Yu, Xinhua; Faris, Nick; Li, Jingshan


    We introduce an example of a rigorous, quantitative method for quality improvement in lung cancer care-delivery. Computer process modeling methods are introduced for lung cancer diagnosis, staging and treatment selection process. Two types of process modeling techniques, discrete event simulation (DES) and analytical models, are briefly reviewed. Recent developments in DES are outlined and the necessary data and procedures to develop a DES model for lung cancer diagnosis, leading up to surgical treatment process are summarized. The analytical models include both Markov chain model and closed formulas. The Markov chain models with its application in healthcare are introduced and the approach to derive a lung cancer diagnosis process model is presented. Similarly, the procedure to derive closed formulas evaluating the diagnosis process performance is outlined. Finally, the pros and cons of these methods are discussed.

  6. Diagnosis and Treatment of Intussusception in Children

    Directory of Open Access Journals (Sweden)

    O.V. Spakhi


    Full Text Available Intussusception is the most common form of acquired gastrointestinal obstruction in children. The aim is to study the features of clinical course and treatment strategy for intussusception in children and to analyze limitations of diagnostic, clinical and special research methods. Materials and methods of the study. The analysis of treatment outcomes has been carried out in 272 children in pediatric surgery clinic from 2004 to 2015. We have developed the objective criteria for evaluation of intussusception stages that correlate with the degree of endotoxemia, changes in respiratory function and circulation, the disorders of gut motility, as well as ultrasound of the abdominal organs. Results and discussion. Patients with intussusception stage I (233 children had no signs of endotoxemia or they were non-significant. In 10 children we performed surgery, in 4 cases — laporoscopically. Of the 32 patients with stage II, in 8 cases the intussusception was straightened conservatively on the first try. We don’t make a second attempt in children with intussusception stage II. Surgical straightening was perfomed in 24 patients. Intussusception stage III in children (7 patients had signs of third degree endotoxemia. All patients of the third stage of intussusception underwent median laparotomy. In 5 cases we have detected intussusceptum necrosis, and these children were made bowel resection followed by the imposition of final ileostomy and intubation of the small intestine. In the rest (2 of patients, we managed to straighten the intussusceptum, and the gut was recognized as vital. Imposing primary anastomosis after the bowel resection in peritonitis we consider unacceptable. Conclusions. 1. Comprehensive survey of children using laboratory and instrumental methods became the basis for the allocation of 3 stages of intussusception, which correlated with the degree of endotoxemia and impaired bowel functions: stage I — compensated; stage II

  7. Diagnosis and treatment of fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius


    /MRI for complete anatomical definition. Any abscess should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated. Treatment goals for perianal fistulas include reduced fistula secretion or none, evaluated by clinical examination; the absence of abscesses; and patient......A fistula is defined as a pathological connection between the intestine and an inner (bladder or other intestine) or outer (vagina or skin) epithelial surface. Fistulas are discovered in up to 25% of all Crohn's disease patients during long-term follow-up examinations. Most are perianal fistulas...... satisfaction. MR imaging is required to demonstrate definitive fistula closure. Fistulotomy is considered for simple perianal fistulas. In complex perianal fistulas, antibiotics and azathioprine or 6-mercaptopurine, which are often combined with a loose seton, constitute the first-line medical therapy...

  8. [Diagnosis and treatment of episcleritis and scleritis]. (United States)

    Tappeiner, C; Walscheid, K; Heiligenhaus, A


    Episcleritis is a benign and self-limiting disease, often with a recurrent course, manifesting mainly in young adults. In less than a third of patients, an associated systemic disease can be found. In contrast, scleritis is observed mainly in patients between the 4th and 6th decade of life, may lead to severe ocular complications, and is often associated with a systemic rheumatological disease. Diffuse, nodular, and necrotizing forms of scleritis can be differentiated. Necrotizing and posterior scleritis have a higher risk of complications and worse visual outcome. In most cases, medical history and slit lamp examination allow differentiation of episcleritis and scleritis. Whereas episcleritis is treated mainly symptomatically with artificial tears, topical corticosteroids, and potentially with systemic nonsteroidal anti-inflammatory drugs, scleritis requires early and aggressive anti-inflammatory treatment in a stepwise approach.

  9. Diagnosis and treatment of cytomegalovirus 2013. (United States)

    Einsele, Hermann; Mielke, Stephan; Grigoleit, Götz Ulrich


    Despite significant improvements in the management of patients undergoing allogeneic stem cell transplantation, including anticytomegalovirus (CMV) prophylaxis and treatment, clinical handling of CMV infection remains challenging in the light of high morbidity and mortality rates. Thus, novel strategies and agents to control CMV infection and disease will be discussed. Novel assays to quantify viral load and detect antiviral resistance mechanisms on the basis of next-generation sequencing have been described and will help to earlier and more effectively control CMV infection. In addition, safer and more effective antiviral agents are now available and strategies to boost the CMV-directed immune responses are being explored in the clinic. Novel diagnostic tests, novel agents and the increased understanding of the immune response to CMV have and will have a major impact on improving the management of CMV infection in hematological patients.

  10. Research advance on diagnosis and treatment for atypical optic neuritis

    Directory of Open Access Journals (Sweden)

    Guo-Yan Zeng


    Full Text Available Optic neuritis(ONis one of the most common causes of vision loss by neural eye diseases in youth and middle-aged. In the past, the diagnosis simply according to the risk position, which did not distinguish from the pathogenesis and clinical characteristics, can not meet the current clinical diagnosis and treatment needs. Combining with the etiology, clinical characteristics and prognosis, the latest classification of the current international diagnosis of ON are typical and atypical ON. Typical ON relates to multiple sclerosis(MSor demyelinating disease of the central nervous system, it has a relatively good therapeutic effect and prognosis. Rather than, atypical ON has complex etiology, clinical manifestation, and the treatment and prognosis are also different. At present there are many international ON treatment guidelines with level I evidence-based medical evidence, but with different genetic background, geographical environment and ethnic groups, they are not been determined. China lacks of such a multicenter large sample, a wide range of research evidence. In this paper, we will summarize the progress of the diagnosis and treatment about ON, especially about the atypical ON, in order to provide some suggestions to further improve the standardization and individualization for clinical diagnosis and treatment on ON.


    Directory of Open Access Journals (Sweden)

    L.K. Aslamazyan


    Full Text Available The article is dedicated to the papilloma virus infection. As it became known in October 2008, the nobel prize in the field of medicine and physiology this year is awarded to the German doctor of Harald Zur Hausen who has proved the role of the human papilloma virus as causative factor of the cervical carcinoma. This is epoch making discovery because of human papilloma virus is most frequent of sexually transmitted infections. The authors demonstrated the high HPV prevalence. One of the most frequent manifestations of this infection is in more details presented pointed condy loma, clinical course of the disease and differential diagnostics of its various forms. Considering treatment inefficiency, the authors convincingly demonstrate that the only opportunity available to keep a human from the illness development is a specific immune prevention.Key words: papillomavirus infection, pointed condylomas, precancers, prevention.

  12. [Infective endocarditis : Update on prophylaxis, diagnosis, and treatment]. (United States)

    Dietz, S; Lemm, H; Janusch, M; Buerke, M


    The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

  13. [Urosepsis. Update on diagnosis and treatment]. (United States)

    Wagenlehner, F M E; Alidjanov, J; Pilatz, A


    Sepsis is an acute systemic response to the presence of bacteria and bacterial components in the macroorganism, and urosepsis is defined as sepsis caused by an infection in the urogenital tract. The urogenital tract is considered to be responsible for about 30 % of the cases of septic processes, whereby obstructive uropathy is causative in about 80 % of these cases. Sepsis manifests as an initially predominant proinflammatory response by widespread release of inflammatory mediators as a result of activation of cells responsive to infectious components such as bacterial toxins, which is then accompanied by a counter-regulatory anti-inflammatory response. Prior to antibiotic therapy, blood and urine cultures are recommended, while procalcitonin and lactate can be considered diagnostically relevant biomarkers. Furthermore, early imaging to localize the level of obstruction and infectious focus should be carried out. Treatment is divided into causal therapy (antimicrobial therapy and infectious source), supportive therapy (fluids and oxygen administration), and adjunctive therapy (sepsis-specific therapy).

  14. [Diagnosis, pathogenesis and treatment of panic attacks]. (United States)

    Turczyński, J

    Panic accompanies several diseases both psychological and somatic. It may be secondary, i.e. produced by other symptoms and morbid processes. It may also be primary--"neurotic". In such cases there are two forms of panic: generalized and paroxysmal. Attacks of panic are seen in 1.6-2.9% of women and in 0.4-1.7% of men. Main pathogenetic role is played by the psychologic factors (psychical trauma precedes the onset of diseases). The role of biological factors is also important. It is believed that disorders of the noradrenergic, serotonin-ergic, and GABA-ergic transmission may produce the attacks of panic. Psychotherapy is a treatment of choice. Pharmacotherapy plays only an adjuvant role. Antidepressants (tricyclic of II generation) are most frequently used for this purpose and--exceptionally due to possible addiction--benzodiazepines. The highest impact on the development of disease has first contact physician attitude. Patient and thoughtful listening to the patient, explanation of the complaints and their source often produce and improvement, and even complete recovery.

  15. Dysthymia and Apathy: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Junko Ishizaki


    Full Text Available Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. It is often difficult to be distinguished from major depression, specifically in its partially remitted state because “loss of interest” or “apathy” tends to prevail both in dysthymia, and remitted depression. Apathy may also occur in various psychiatric and neurological disorders, including schizophrenia, stroke, Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia. It is symptomatologically important that apathy is related to, but different from, major depression from the viewpoint of its causes and treatment. Antidepressants, especially noradrenergic agents, are useful for depression-related apathy. However, selective serotonin reuptake inhibitors (SSRIs may be less effective for apathy in depressed elderly patients and have even been reported to worsen apathy. Dopaminergic agonists seem to be effective for apathy. Acetylcholine esterase inhibitors, methylphenidate, atypical antipsychotics, nicergoline, and cilostazol are another choice. Medication choice should be determined according to the background and underlying etiology of the targeting disease.

  16. Diagnosis and treatment of Basal cell and squamous cell carcinoma. (United States)

    Firnhaber, Jonathon M


    Family physicians are regularly faced with identifying, treating, and counseling patients with skin cancers. Nonmelanoma skin cancer, which encompasses basal cell and squamous cell carcinoma, is the most common cancer in the United States. Ultraviolet B exposure is a significant factor in the development of basal cell and squamous cell carcinoma. The use of tanning beds is associated with a 1.5-fold increase in the risk of basal cell carcinoma and a 2.5-fold increase in the risk of squamous cell carcinoma. Routine screening for skin cancer is controversial. The U.S. Preventive Services Task Force cites insufficient evidence to recommend for or against routine whole-body skin examination to screen for skin cancer. Basal cell carcinoma most commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels. Squamous cell carcinoma most commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration. Initial tissue sampling for diagnosis involves a shave technique if the lesion is raised, or a 2- to 4-mm punch biopsy of the most abnormal-appearing area of skin. Mohs micrographic surgery has the lowest recurrence rate among treatments, but is best considered for large, high-risk tumors. Smaller, lower-risk tumors may be treated with surgical excision, electrodesiccation and curettage, or cryotherapy. Topical imiquimod and fluorouracil are also potential, but less supported, treatments. Although there are no clear guidelines for follow-up after an index nonmelanoma skin cancer, monitoring for recurrence is prudent because the risk of subsequent skin cancer is 35 percent at three years and 50 percent at five years.

  17. Importance of MRI in the diagnosis and treatment of rhabdomyolysis

    International Nuclear Information System (INIS)

    Moratalla, Monica Ballesta; Braun, Petra; Fornas, Guillermina Montoliu


    Background: Rhabdomyolysis is a common disorder resulting from a large variety of causes. We describe the MRI features and their importance for diagnosis and treatment. Patients and methods: Between 2003 and 2006, four male patients (age range: 25-33 years) with rhabdomyolysis were studied via 1.5 T MRI (GE, Siemens). In all the patients, T1- and T2-weighted sequences with and without fat suppression, short tau inversion recovery (STIR) and gradient-echo sequences were obtained in axial, coronal and sagittal planes. In one patient, contrast material was given. Results: Two patients presented rhabdomyolysis due to drug abuse, one due to intense exercise and the last one due to long unconsciousness with compression of the paravertebral musculature. Two patients had acute kidney failure. The affected muscles showed an increased signal intensity on T2-weighted and STIR sequences and decreased on T1-weighted sequences. In one patient, intramuscular hemorrhage was observed on T1-weighted and gradient-echo sequences. In the patient with kidney failure, a globular swelling of the kidney with alteration of the corticomedullary differentiation on T2-weighted sequences with fat saturation and hypointensity of the renal medulla on T1-weighted contrast enhanced images was found. Discussion: Immediate recognition of rhabdomyolysis is important to prevent late complications. MRI is the method of choice to evaluate the distribution and extension of the affected muscles, especially when fasciotomy is considered for treatment. Even though the MRI findings are non-specific, the sensitivity in the detection of muscle involvement is higher than CT or US

  18. Importance of MRI in the diagnosis and treatment of rhabdomyolysis

    Energy Technology Data Exchange (ETDEWEB)

    Moratalla, Monica Ballesta [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)], E-mail:; Braun, Petra; Fornas, Guillermina Montoliu [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)


    Background: Rhabdomyolysis is a common disorder resulting from a large variety of causes. We describe the MRI features and their importance for diagnosis and treatment. Patients and methods: Between 2003 and 2006, four male patients (age range: 25-33 years) with rhabdomyolysis were studied via 1.5 T MRI (GE, Siemens). In all the patients, T1- and T2-weighted sequences with and without fat suppression, short tau inversion recovery (STIR) and gradient-echo sequences were obtained in axial, coronal and sagittal planes. In one patient, contrast material was given. Results: Two patients presented rhabdomyolysis due to drug abuse, one due to intense exercise and the last one due to long unconsciousness with compression of the paravertebral musculature. Two patients had acute kidney failure. The affected muscles showed an increased signal intensity on T2-weighted and STIR sequences and decreased on T1-weighted sequences. In one patient, intramuscular hemorrhage was observed on T1-weighted and gradient-echo sequences. In the patient with kidney failure, a globular swelling of the kidney with alteration of the corticomedullary differentiation on T2-weighted sequences with fat saturation and hypointensity of the renal medulla on T1-weighted contrast enhanced images was found. Discussion: Immediate recognition of rhabdomyolysis is important to prevent late complications. MRI is the method of choice to evaluate the distribution and extension of the affected muscles, especially when fasciotomy is considered for treatment. Even though the MRI findings are non-specific, the sensitivity in the detection of muscle involvement is higher than CT or US.

  19. Toxic Stress: Effects, Prevention and Treatment. (United States)

    Franke, Hillary A


    Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP) Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.

  20. Prevention and Treatment of Breast Cancer (United States)


    pregnant 1>2 (41) 1ɚ (42) Pregnant, Black Pregnant, White 1>2 (20) 1ɚ (43) Pregnant, lean Pregnant, obese 1>2 (20) 1ɚ (22) Pregnant, consuming no...pregnant rats with AFPep showed no disruption of the estrous cycle, no effect on fecundity or fertility , and no evidence of teratogencity. (87) While...Bennett JA, Andersen TT. AFPep, a novel drug for the prevention and treatment of breast cancer, does not disrupt the estrous cycle or fertility in

  1. Diagnosis and treatment of superficial vein thrombosis. (United States)

    Bauersachs, R M


    Superficial vein thrombosis (SVT) is a common disease, characterized by an inflammatory-thrombotic process in a superficial vein. Typical clinical findings are pain and a warm, tender, reddish cord along the vein. Until recently, no reliable epidemiological data were available. The incidence is estimated to be higher than that of deep-vein thrombosis (DVT) (1/1000). SVT shares many risk factors with DVT, but affects twice as many women than men and frequently occurs in varicose veins. Clinically, SVT extension is commonly underestimated, and patients may have asymptomatic DVT. Therefore, ultrasound assessment and exclusion of DVT is essential. Risk factors for concomitant DVT are recent hospitalization, immobilization, autoimmune disorders, age > 75 years, prior VTE, cancer and SVT in non-varicose veins. Even though most patients with isolated SVT (without concomitant DVT or PE) are commonly treated with anticoagulation for a median of 15 days, about 8% experience symptomatic thromboembolic complications within three months. Risk factors for occurrence of complications are male gender, history of VTE, cancer, SVT in a non-varicose vein or SVT involving the sapheno-femoral junction (SFJ). As evidence supporting treatment of isolated SVT was sparse and of poor quality, the large, randomized, double-blind, placebo-controlled CALISTO trial was initiated assessing the effect of fondaparinux on symptomatic outcomes in isolated SVT. This study showed that, compared with placebo, 2.5 mg fondaparinux given for 45 days reduced the risk of symptomatic thromboembolic complications by 85% without increasing bleeding. Based on CALISTO and other observational studies, evidence-based recommendations can be made for the majority of SVT patients. Further studies can now be performed in higher risk patients to address unresolved issues.

  2. Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications

    Directory of Open Access Journals (Sweden)

    DING Huiguo


    Full Text Available Guidelines for the diagnosis and treatment of cirrhotic ascites and related complications put forward the new criteria for the diagnosis and treatment of intractable cirrhotic ascites, and spontaneous bacterial peritonitis is a common cause of intractable cirrhotic ascites. About 50%-89% of patients with intractable cirrhotic ascites have a significant response to terlipressin (2-8 mg/d, midodrine hydrochloride (22.5 mg/d, and tolvaptan (7.5-15 mg/d. Intravenous albumin supplementation (8 g/1000 ml ascites has a similar therapeutic effect as terlipressin (3 mg in preventing posterior circulation dysfunction after large-volume paracentesis. Patients with a poor response to medication or those who need frequent large-volume paracentesis (more than three times per week or frequent hospitalization (more than three times per month should be evaluated for liver transplantation or transjugular intrahepatic portosystemic shunt. α-Crystal rifaximin may become a new strategy for preventing complications of liver cirrhosis by regulating the intestine-microbe-liver axis. Therefore, it is of great significance to explore the “road map” of the diagnosis and treatment of intractable cirrhotic ascites that is suitable for the clinical practice in China.

  3. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

    NARCIS (Netherlands)

    Brouwer, Matthijs C.; Tunkel, Allan R.; van de Beek, Diederik


    The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the

  4. prevention decreased sexual risk behaviour after the diagnosis of ...

    African Journals Online (AJOL)


    Dec 1, 2006 ... Condom use with casual partners increased from 53% among the men and 46% among the women before the diagnosis ... Conclusions. The ART had an overall positive effect on health with no increase of sexual risk behaviour. ... were calculated by a statistician using the computer program for binominal ...

  5. Jugular foramen tumors: diagnosis and treatment. (United States)

    Ramina, Ricardo; Maniglia, Joao Jarney; Fernandes, Yvens Barbosa; Paschoal, Jorge Rizzato; Pfeilsticker, Leopoldo Nizan; Neto, Mauricio Coelho; Borges, Guilherme


    %) experienced postoperative CSF leakage, and four (4.2%) died after surgery. Two of them died of aspiration pneumonia complicated with septicemia. Of the remaining two, one died of pulmonary embolism and the other of cerebral hypoxia caused by a large cervical hematoma that led to tracheal deviation. Paragangliomas are the most common tumors of the jugular foramen region. Surgical management of jugular foramen tumors is complex and difficult. Radical removal of benign jugular foramen tumors is the treatment of choice, may be curative, and is achieved with low mortality and morbidity rates. Larger lesions can be radically excised in one surgical procedure by using a multidisciplinary approach. Reconstruction of the skull base with vascularized myofascial flaps reduces postoperative CSF leaks. Postoperative lower cranial nerves deficits are the most dangerous complication.

  6. [Pain in herpes zoster: Prevention and treatment]. (United States)

    Calvo-Mosquera, G; González-Cal, A; Calvo-Rodríguez, D; Primucci, C Y; Plamenov-Dipchikov, P

    Shingles is a painful rash that results from reactivation of latent varicella-zoster virus in the dorsal root ganglia or cranial nerves. In this article an update is presented on the prevention and pharmacological treatment of the secondary pain from the virus infection. The most effective way to prevent post-herpetic neuralgia and its consequences is the prevention of herpes itself. A live attenuated vaccine (the Oka strain varicella zoster virus) has been available for several years, and is approved in adults aged 50 years old. Although this vaccine has shown to be effective against herpes zoster and post-herpetic neuralgia, its effectiveness decreases with age and is contraindicated in patients with some form of immunosuppression. Today the recombinant vaccines provide an alternative, and may be administered to immunocompromised persons. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Childhood night terrors and sleepwalking: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Sachin Ratan Gedam


    Full Text Available Night terrors and sleepwalking are arousal disorders that occur during the first third of night. Combined existence of sleep disorders are rare phenomenon and found to be associated with behavioural and emotional problems. It becomes difficult to diagnose among sleep disorders and epilepsy is an important differential diagnosis. Management with combined approach of pharmacotherapy and psychological counselling is safe and effective. Here, we present a case of night terrors and sleepwalking to highlight the importance of diagnosis and treatment in this condition. To conclude, all medical professionals need to be aware of different parasomnias and its treatment options.

  8. An update on the diagnosis and treatment of dens invaginatus. (United States)

    Zhu, J; Wang, X; Fang, Y; Von den Hoff, J W; Meng, L


    Dens invaginatus is a malformation with varying anatomical features, posing challenges to treatment. Early and accurate diagnosis plays a significant role in selecting the appropriate treatment. The diagnosis of teeth with a complex root canal system including dens invaginatus has made progress with the application of three-dimensional imaging techniques in endodontics. Advanced treatment options provide hope for teeth that could not be saved before. This review discusses diagnostic methods and treatment options for teeth with dens invaginatus, and provides guidelines for the management of dens invaginatus cases in clinic. Current as well as traditional diagnostic techniques are summarized. Treatment options including state-of-the-art alternatives are presented for coronal dens invaginatus and radicular dens invaginatus. © 2017 Australian Dental Association.

  9. Neonatal pressure ulcers: prevention and treatment

    Directory of Open Access Journals (Sweden)

    García-Molina P


    Full Text Available Pablo García-Molina,1,2 Alba Alfaro-López,1 Sara María García-Rodríguez,1 Celia Brotons-Payá,1 Mari Carmen Rodríguez-Dolz,1,2 Evelin Balaguer-López1,2 1Department of Nursing, University of Valencia, 2Research Group of Pediatric Nutrition, INCLIVA Foundation, Valencia, Spain Abstract: Health professionals should be prepared to respond to the needs of hospitalized neonates. The health team must consider multiple situations, where the neonate is at risk of having an adverse effect. One of the main interventions that health professionals must practice when interacting with hospitalized newborns is skin care. Neonates often suffer from diaper rash or intravenous drugs extravasation. Recently, hospitalized neonates and especially those in an unstable clinical situation are also at a risk of developing pressure ulcers. The presence of a pressure ulcer in a neonate can lead to serious problems to survival (eg, sepsis, clinical instability. This is the reason why, with this literature review, we attempt to answer questions from health professionals caring for neonates about the prevention and treatment of pressure ulcers. Keywords: infant, pressure ulcer, treatment, prevention, wound, assessment

  10. Intermittent preventive treatment of malaria in pregnancy

    DEFF Research Database (Denmark)

    Mbonye, A.K.; Bygbjerg, Ib Christian; Magnussen, Pascal


    OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. METHODS: A non-randomized comm......OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. METHODS: A non......-randomized community trial was implemented in 21 community clusters (intervention) and four clusters where health units provided routine IPTp (control). The primary outcome measures were access and adherence to IPTp, number of malaria episodes, prevalence of anaemia, and birth weight. Numbers of live births, abortions......, still births, and maternal and child deaths were secondary endpoints. FINDINGS: 1404 (67.5%) of 2081 with the new delivery system received two doses of sulfadoxine-pyrimethamine versus 281 (39.9%) of 704 with health units (P malaria episodes decreased from 906 (49...

  11. Update on Diagnosis, Management, and Prevention of Hepatitis B Virus Infection (United States)


    1971. Viral hepatits type B MS-2 strain): studies on active immunization. JAMA 217:41-45. Lau, J. Y. N., and T. L. Wright. 1993. Molecular virology...PUBLICATION REPORT 1906 06/99 UPDATE ON DIAGNOSIS, MANAGEMENT, AND PREVENTION OF HEPATITIS B VIRUS INFECTION By Francis J. Mahoney U.S. NAVAL...MICROBIOLOGY REVIEWS, Apr. 1999, p. 351-366 0893-8512/99/$04.00+0 Vol. 12, No. 2 Update on Diagnosis, Management, and Prevention of Hepatitis B

  12. Multidrug-resistant Fusarium keratitis: diagnosis and treatment considerations. (United States)

    Sara, Sergio; Sharpe, Kendall; Morris, Sharon


    Mycotic keratitis is an ocular infective process derived from any fungal species capable of corneal invasion. Despite its rarity in developed countries, its challenging and elusive diagnosis may result in keratoplasty or enucleation following failed medical management. Filamentous fungi such as Fusarium are often implicated in mycotic keratitis. Bearing greater morbidity than its bacterial counterpart, mycotic keratitis requires early clinical suspicion and initiation of antifungal therapy to prevent devastating consequences. We describe a case of multidrug-resistant mycotic keratitis in a 46-year-old man who continued to decline despite maximal therapy and therapeutic keratoplasty. Finally, enucleation was performed as a means of source control preventing dissemination of a likely untreatable fungal infection into the orbit. Multidrug-resistant Fusarium is rare, and may progress to endophthalmitis. We discuss potential management options which may enhance diagnosis and outcome in this condition. 2016 BMJ Publishing Group Ltd.

  13. Imaging of hepatocellular carcinoma: diagnosis, staging and treatment monitoring (United States)

    Hennedige, Tiffany


    Abstract Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Imaging is important for establishing a diagnosis of HCC. Several imaging modalities including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and angiography are used in evaluating patients with chronic liver disease and suspected HCC. CT, MRI and contrast-enhanced US have replaced biopsy for diagnosis of HCC. Dynamic multiphase contrast-enhanced CT or MRI is the current standard for imaging diagnosis of HCC. Functional imaging techniques such as perfusion CT and diffusion-weighted MRI provide additional information about tumor angiogenesis that may be useful for treatment. Techniques evaluating tissue mechanical properties such as magnetic resonance elastography, and acoustic radiation force impulse imaging are being explored for characterizing liver lesions. The role of PET in the evaluation of HCC is evolving with promise seen especially with the use of a hepatocyte-specific PET tracer. Imaging is also critical for assessment of treatment response and detection of recurrence following locoregional treatment. Knowledge of the post-treatment appearance of HCC is essential for correct interpretation. This review article provides an overview of the role of imaging in the diagnosis, staging and post-treatment follow-up of HCC. PMID:23400006

  14. Detection and diagnosis of periodontal conditions amenable to prevention


    Preshaw, Philip M


    Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory diseases. Gingivitis affects the majority of people, and advanced periodontitis is estimated to affect 5-15% of adults. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. All patients should undergo periodontal assessment as part of routine oral examination. Periodontal screening using methods such as the Basic Periodontal Examination/Community Periodont...

  15. Anterior knee pain in the young athlete: diagnosis and treatment. (United States)

    Kodali, Pradeep; Islam, Andrew; Andrish, Jack


    The underlying etiology of anterior knee pain has been extensively studied. Despite many possible causes, often times the diagnosis is elusive. The most common causes in the young athlete are osteosynchondroses, patellar peritendinitis and tendinosis, synovial impingement, malalignment, and patellar instability. Less common causes are osteochondritis dissecans and tumors. It is always important to rule out underlying hip pathology and infections. When a diagnosis cannot be established, the patient is usually labeled as having idiopathic anterior knee pain. A careful history and physical examination can point to the correct diagnosis in the majority of cases. For most of these conditions, treatment is typically nonoperative with surgery reserved for refractory pain for an established diagnosis.

  16. Diagnosis as the First Critical Point in the Treatment Trajectory

    DEFF Research Database (Denmark)

    Missel, Malene; Pedersen, Jesper H; Hendriksen, Carsten


    of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization. METHODS: We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here...... the patient to face a new life situation, and demands one-on-one supportive care. CONCLUSIONS: Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient......-tailored one-on-one information. IMPLICATIONS FOR PRACTICE: This article contributes to the knowledge base of support needs of lung cancer patients. Interventions aimed at supportive care during the period between diagnosis and surgical intervention should be researched....

  17. Atrio-Esophageal Fistula After AF Ablation: Pathophysiology, Prevention &Treatment. (United States)

    Pappone, Carlo; Vicedomini, Gabriele; Santinelli, Vincenzo


    Atrioesophageal fistula is an extremely rare but often fatal late complication of atrial fibrillation ablation procedures resulting from massive thermal injury to the esophagus and surrounding structures. Causes of death include cerebral air embolism, massive gastrointestinal bleeding, and septic shock. Because of its exceptionally low rate of occurrence, no predictors of lesion development have been found and there has not been an uniform approach to either early diagnosis or corrective therapy. Currently, preventive strategies include empirically reducing power titration during PVI and/or while ablating the posterior left atrial wall, limiting energy delivery time and number, avoiding overlapping ablation lines as well as monitoring intraluminal esophageal temperature. In addition, it has been suggested to use conscious sedation rather than general anesthesia for better pain perception, monitoring intraprocedural esophageal position in relation to the posterior left atrium and extensive patient education regarding signs and symptoms of esophageal injury. Early diagnosis is essential to enable an aggressive treatment including stenting and/or surgical intervention to minimize the excessive morbidity and mortality associated with this condition. Unfortunately, despite application of such preventive measures, cases of complete atrial-esophageal fistula have still been reported.

  18. SGLT2 Inhibitor-associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis. (United States)

    Goldenberg, Ronald M; Berard, Lori D; Cheng, Alice Y Y; Gilbert, Jeremy D; Verma, Subodh; Woo, Vincent C; Yale, Jean-François


    Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the newest class of antihyperglycemic agents available on the market. Regulator warnings and concerns regarding the risk of developing diabetic ketoacidosis (DKA), however, have dampened enthusiasm for the class despite the combined glycemic, blood pressure, and occasional weight benefits of SGLT2 inhibitors. With the goal of improving patient safety, a cross-Canada expert panel and writing group were convened to review the evidence to-date on reported SGLT2 inhibitor-related DKA incidents and to offer recommendations for preventing and recognizing patients with SGLT2 inhibitor-associated DKA. Reports covering DKA events in subjects taking SGLT2 inhibitors that were published in PubMed, presented at professional conferences, or in the public domain from January 2013 to mid-August 2016 were reviewed by the group independently and collectively. Practical recommendations for diagnosis and prevention were established by the panel. DKA is rarely associated with SGLT2 inhibitor therapy. Patients with SGLT2 inhibitor-associated DKA may be euglycemic (plasma glucose level diabetes, including those with type 2 diabetes, and is typically precipitated by insulin omission or dose reduction, severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets, or excessive alcohol intake. SGLT2 inhibitor-associated DKA may be prevented by withholding SGLT2 inhibitors when precipitants develop, avoiding insulin omission or inappropriate insulin dose reduction, and by following sick day protocols as recommended. Preventive strategies should help avoid SGLT2 inhibitor-associated DKA. All SGLT2 inhibitor-treated patients presenting with signs or symptoms of DKA should be suspected to have DKA and be investigated for DKA, especially euglycemic patients. If DKA is diagnosed, SGLT2 inhibitor treatment should be stopped, and the DKA should be treated with a traditional treatment protocol. Copyright © 2016 Elsevier

  19. Role of STD Detection and Treatment in HIV Prevention (United States)

    ... Sheet Treatment and Care Other Resources Archive STD Treatment to Prevent HIV Infection STDs Home Page Bacterial Vaginosis (BV) Chlamydia ... and prevent spreading STDs to your sex partners. Treatment for an STD other than HIV does not prevent the spread of HIV. If ...

  20. [Technical guidelines for the prevention and treatment of chikungunya fever]. (United States)

    Barrera-Cruz, Antonio; Díaz-Ramos, Rita Delia; Viniegra-Osorio, Arturo; Grajales-Muñiz, Concepción; Dávila-Torres, Javier


    Chikungunya fever is an emerging disease caused by an alphavirus belonging to the Togaviridae family, transmitted by the bite of Aedes genus species: Aedesaegypti and Aedesalbopictus. In 2013, PAHO/WHO received confirmation of the first cases of indigenous transmission of chikungunya in the Americas. This disease may be acute, subacute and chronic, affecting all age groups. Following an incubation period from three to seven days, the patient usually begins with a high fever (greater than 39 °C), arthralgia, back pain, headache, nausea, vomiting, arthritis, rash, and conjunctivitis (acute phase: 3-10 days). Most patients recover fully, but in some cases, joint involvement may persist chronically and cause discapacity and affect life quality. Serious complications are rare, however, attention must be focused on vulnerable populations (the elderly, children and pregnant women). So far, there is no specific antiviral treatment or effective vaccine, so it is giving priority symptomatic and supportive treatment for the acute phase and make an early diagnosis of atypical and severe forms, and to implement effective prevention and control measures. Given the eco-epidemiological conditions and distribution of vectors in the region of the Americas, the spread of the virus to other countries is likely, so that health professionals should be aware of and identify risk factors and major clinical manifestations, allow timely prevention and safe and effective treatment of this disease.

  1. Dietary supplement use and colorectal tumors : from prevention to diagnosis

    NARCIS (Netherlands)

    Bröring, R.C.


    Background: Expert guidelines formulated by the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) advised no use of dietary supplements for cancer prevention. However, it is unclear whether those recommendations also apply to populations at high

  2. Incorporating diagnosis and treatment of hyperhidrosis into clinical practice. (United States)

    Pariser, David M


    Proper billing and coding are essential to document the diagnosis of hyperhidrosis and to assure proper reimbursement for treatment. Providers should become familiar with the payment policies of local health plans to streamline the preauthorization process that is often needed for many treatments commonly used for hyperhidrosis. Having a preprinted letter of medical necessity and patient intake forms that record the necessary historical information about the disease, previous treatments, and other pertinent information will help increase the speed of the office flow. This article presents algorithms for treatment of the various forms of primary focal hyperhidrosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Sportsman hernia; the review of current diagnosis and treatment modalities. (United States)

    Paksoy, Melih; Sekmen, Ümit


    Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.

  4. Stage at diagnosis, clinicopathological and treatment patterns of ...

    African Journals Online (AJOL)

    Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer.

  5. Diagnosis and Treatment of Three-Rooted Maxillary Premolars (United States)

    Arisu, Hacer Deniz; Alacam, Tayfun


    Anatomical variations must be considered in clinical and radiographical evaluations during endodontic treatment. Access cavity modifications may be required for stress free entry to complex anatomy. Higher magnification and illumination can be useful for access cavity preparation and to recognize and locate additional canals. This article describes the diagnosis and clinical management of two clinical cases of three rooted maxillary premolars. PMID:19262733

  6. Knowledge and practice on magnitude, diagnosis, treatment and ...

    African Journals Online (AJOL)


    1Department of Medical Microbiology Immunology and Parasitology, College of Medicine and Health Sciences, ... the burden, risk factors, diagnosis modalities, surveillance strategies and treatment approaches to HCC in Ethiopia. ... HCC is clinically characterized by exhaustion, loss of appetite, rapid loss of weight,.

  7. Challenge in diagnosis and treatment of colonic carcinoma ...

    African Journals Online (AJOL)

    Introduction: Despite advances in perioperative care and operative techniques, urgent colorectal operations are still associated with higher mortality and morbidity than elective surgery. Aim: This study was to identify the challenge in diagnosis and treatment of emergencies caused by colon carcinoma; and to assess its ...

  8. Acute bronchitis: general practitioners' views regarding diagnosis and treatment.

    NARCIS (Netherlands)

    Verheij, T.J.M.; Hermans, J.; Kaptein, A.A.; Wijkel, D.; Mulder, J.D.


    A survey was conducted among 800 Dutch general practitioners to establish their views on the diagnosis and treatment of bronchitis and related disorders with reference to 12 theoretical patients. The answers of the 467 respondents (response rate 60%) showed no clear relationship between signs and

  9. Gastric cancer diagnosis and treatment guidelines 2008: Uganda ...

    African Journals Online (AJOL)

    In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the ...

  10. Hymenoptera venom allergy : Challenges in diagnosis and treatment

    NARCIS (Netherlands)

    Vos, Byrthe


    This thesis gives an overview of some of the main challenges and controversies in the understanding, diagnosis, and treatment of insect allergy and provides a practical guidance for clinical decision-making. A special focus is given to patients with concurrent indolent systemic mastocytosis (ISM)

  11. - 1 - Stage at diagnosis, clinicopathological and treatment patterns of ...

    African Journals Online (AJOL)

    Abstract: Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer.

  12. Interocclusal Registration for Diagnosis and Treatment Planning for ...

    African Journals Online (AJOL)


    Sep 14, 2017 ... implant case where multiple posterior teeth are missing and need to be replaced by implant restorations. In the case ... Keywords: Interocclusal Records, Diagnosis and Treatment Plan, Implant. Restorations. Interocclusal ... then removed to leave a window in the acrylic resin. The appliance was finished ...

  13. Helicobacter pylori in childhood : aspects of prevalence, diagnosis and treatment

    NARCIS (Netherlands)

    Mourad-Baars, Petronella Elisabeth Cornelia


    In this dissertation we present the results of our research on Helicobacter pylori infections in childhood, focusing on the prevalence, diagnosis and treatment of the infection. Our studies were conducted in the Netherlands, Europe and Indonesia. We discuss diagnostic tests, therapeutic regimens,

  14. diagnosis and treatment of heart failure in the community

    African Journals Online (AJOL)


    saying 'Many roads lead to a broken heart' (Fig. 1). CLASSIFICATION. The current staging of heart failure takes ... is coronary artery disease in black. Africans. DIAGNOSIS AND TREATMENT OF. HEART ... Systemic hypertension, coronary artery disease, diabetes because of the presence of conditions mellitus, history of ...

  15. Premenstrual Syndromes - An Approach to Diagnosis and Treatment

    African Journals Online (AJOL)

    Premenstrual Syndromes - An Approach to. Diagnosis and Treatment. Swart P, MBChB, MMed (O & G). Dreyer G, MBChB, MMed (O & G). Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria. Correspondence to: Prof Greta Dreyer, E-mail: Abstract. SA Fam ...

  16. Prevention vs. treatment: what's the right balance?

    National Research Council Canada - National Science Library

    Faust, Halley S; Menzel, Paul T


    .... This book explores this observation by examining the actual spending on prevention, the history of health policies and structural features that affect prevention's apparent relative lack of emphasis...

  17. Preimplantation genetic diagnosis in the prevention of the haemoglobin disorders

    Directory of Open Access Journals (Sweden)

    S. Kahraman


    Full Text Available Preimplantation Genetic Diagnosis (PGD is currently an alternative for couples with high risk of pregnancies with genetic anomalies; it offers the possibility of avoiding the need to terminate affected pregnancies, since it allows the selection of unaffected embryos for transfer. PGD for inherited disorders has become extremely accurate (99.5%, and may currently be performed for any single gene disorders in which mutation is identified. PGD has been performed for more than 100 different conditions resulting in the birth of at least 1000 healthy children free of genetic disorder. PGD is presently also used together with preimplantation HLA typing for treatment of affected sibling with genetic and acquired disorders requiring HLA matched stem cell transplantation. This is not only to allow couples to have an unaffected child but also to select a potential donor progeny for stem cell transplantation. In Turkey, thalassemia is the most commonly seen genetic disorder the rate of thalassemia carriers is about 3 - 4% in Turkey. The majority of our PGD cases are thalassemia carriers. They do not only require thalassemia mutation analysis but also HLA typing for their affected child. In this study PGD results of 236 Turkish couples with or without HLA typing will be presented and discussed. A full diagnosis was achieved in 91.0% of the biopsied samples. In Group I, 17.8% of the analyzed embryos were found to be HLA compatible. HLA compatible and disease free embryos were 12.9% of all diagnosed embryos. In group II, 17.2% of embryos were found to be HLA matched and 71.4% HLA non-matched. The majority of our HLA typing combined with PGD cases were β-Thalassemia carriers (87.9%. The mutations analyzed have high heterogeneity, the most frequent mutation was IVS-I-110 G-A and comprised 46.2% of all mutations. To date, 70 healthy and HLA compatible children have been born. Twenty-five sick children have already been cured with cord blood cell and/or bone

  18. Detection and diagnosis of periodontal conditions amenable to prevention. (United States)

    Preshaw, Philip M


    Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory diseases. Gingivitis affects the majority of people, and advanced periodontitis is estimated to affect 5-15% of adults. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. All patients should undergo periodontal assessment as part of routine oral examination. Periodontal screening using methods such as the Basic Periodontal Examination/Community Periodontal Index or Periodontal Screening Record should be performed for all new patients, and also on a regular basis as part of ongoing oral health care. If periodontitis is identified, full periodontal assessment is required, involving recording of full mouth probing and bleeding data, together with assessment of other relevant parameters such as plaque levels, furcation involvement, recession and tooth mobility. Radiographic assessment of alveolar bone levels is driven by the clinical situation, and is required to assess bone destruction in patients with periodontitis. Risk assessment (such as assessing diabetes status and smoking) and risk management (such as promoting smoking cessation) should form a central component of periodontal therapy. This article provides guidance to the oral health care team regarding methods and frequencies of appropriate clinical and radiographic examinations to assess periodontal status, to enable appropriate detection and diagnosis of periodontal conditions.

  19. Detection and diagnosis of periodontal conditions amenable to prevention (United States)


    Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory diseases. Gingivitis affects the majority of people, and advanced periodontitis is estimated to affect 5-15% of adults. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. All patients should undergo periodontal assessment as part of routine oral examination. Periodontal screening using methods such as the Basic Periodontal Examination/Community Periodontal Index or Periodontal Screening Record should be performed for all new patients, and also on a regular basis as part of ongoing oral health care. If periodontitis is identified, full periodontal assessment is required, involving recording of full mouth probing and bleeding data, together with assessment of other relevant parameters such as plaque levels, furcation involvement, recession and tooth mobility. Radiographic assessment of alveolar bone levels is driven by the clinical situation, and is required to assess bone destruction in patients with periodontitis. Risk assessment (such as assessing diabetes status and smoking) and risk management (such as promoting smoking cessation) should form a central component of periodontal therapy. This article provides guidance to the oral health care team regarding methods and frequencies of appropriate clinical and radiographic examinations to assess periodontal status, to enable appropriate detection and diagnosis of periodontal conditions. PMID:26390822

  20. Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention. (United States)

    Mount, Hillary R; Boyle, Sean D


    The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. Bacterial meningitis is a medical emergency that requires prompt recognition and treatment. Mortality remains high despite the introduction of vaccinations for common pathogens that have reduced the incidence of meningitis worldwide. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7.6 per 100,000 adults. Most cases of aseptic meningitis are viral and require supportive care. Viral meningitis is generally self-limited with a good prognosis. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Because clinical findings are also unreliable, the diagnosis relies on the examination of cerebrospinal fluid obtained from lumbar puncture. Delayed initiation of antibiotics can worsen mortality. Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis. Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics. Vaccination against the most common pathogens that cause bacterial meningitis is recommended. Chemoprophylaxis of close contacts is helpful in preventing additional infections.

  1. [Recommendations of the European Society of Cardiology and the European Atherosclerosis Society on Cardiovascular Disease Prevention and Management of Dyslipidemias. for the Diagnosis of Atherosclerosis and Dyslipidemia Treatment (2016): Basic S.G. (United States)

    Bubnova, M G; Kukharchuk, V V


    This review summarizes the main provisions of the new, issued in 2016, recommendations of the European Society of Cardiology and Atherosclerosis Society in cooperation with the European Association on Cardiovascular Prevention and Rehabilitation on Cardiovascular disease prevention and Management of dyslipidemia. In these recommendations, the following trends can be traced distinctly: priority in primary prevention is given to non-drug methods of influence; targets of hypolipidemic therapy are identified not only for low density lipoprotein (LDL) cholesterol (CH), but also for non-high density lipoprotein (HDL) CH, especially in cases of concomitant hypertriglyceridemia. In the field of therapy, in which statins remain the main tool of correction of hyperlipidemia, it is recommended to more widely resort to the use of combination therapy, especially in cases of familial hypercholesterolemia or intolerance to statins; introduction of a new class of drugs- inhibitors of proprotein convertase subtilisin/kexin type 9 makes it possible to further reduce the level of LDLCH, lipoprotein(a) more than 60%. Regarding the wider application of these drugs there are issues related to the relatively limited experience of their use and the lack of data on long-term results and the incidence of side effects. Much attention is paid to more active correction of dyslipidemia in elderly patients, patients with chronic renal failure, diabetes, and several other diseases. The emergence of new European recommendations will undoubtedly serve as a stimulus to the revision of the Russian recommendations, which remain unchanged from 2012.

  2. Diagnosis, therapy, and prevention of the cracked tooth syndrome. (United States)

    Geurtsen, Werner; Schwarze, Thomas; Günay, Huesamettin


    Many morphologic, physical, and iatrogenic factors, such as deep grooves, pronounced intraoral temperature fluctuation, poor cavity preparation design, and wrong selection of restorative materials, may predispose posterior teeth to an incomplete fracture. The resulting cracked tooth syndrome is frequently associated with bizarre symptoms that may complicate diagnosis and can persist for many years. Epidemiologic data reveal that splits or fractures are the third most common cause of tooth loss in industrialized countries, primarily affecting maxillary molars and premolars and mandibular molars. This finding indicates that the cracked tooth syndrome is of high clinical importance. Thus, at-risk teeth should be reinforced early, for instance by castings with cusp coverage or by internal splinting with adhesive ceramic restorations.

  3. Pelvic Inflammatory Disease: Diagnosis And Treatment In The Emergency Department. (United States)

    Bugg, Charles Walter; Taira, Taku


    Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and evolving resistance patterns among pelvic inflammatory disease pathogens are reviewed.

  4. Assessment, Diagnosis, and Treatment of Binge Eating Disorder. (United States)

    Ambrogne, Janet A


    Binge eating disorder (BED) is the most prevalent eating disorder in the United States, believed to affect an estimated 2.8 million adults. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, BED was recognized as a separate diagnosis. The purpose of the current article is to provide an overview of BED including assessment, diagnosis, and current pharmacological and nonpharmacological treatment options. Implications for nursing are also addressed. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 32-38.]. Copyright 2017, SLACK Incorporated.

  5. Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

    Directory of Open Access Journals (Sweden)

    Muhammed Dagkiran


    Full Text Available Benign paroxysmal positional vertigo is the cause of peripheral vertigo, which only takes seconds posed by certain head and body position and led to severe attacks of vertigo. Therefore, it is a disturbance that causes a continuous fear of fall and anxiety in some patients. Although benign paroxysmal positional vertigo is the most common cause of peripheral vertigo, it may cause unnecessary tests, treatment costs and the loss of labor due to the result of the delay in the diagnosis and treatment stages. Diagnosis and treatment of this disease is easy. High success rates can be achieved with appropriate repositioning maneuvers after taking a detailed medical history and accurate assessment of accompanying nystagmus. The aim of this paper was to review the updated information about benign paroxysmal positional vertigo. [Archives Medical Review Journal 2015; 24(4.000: 555-564

  6. Naegleria fowleri: Diagnosis, Pathophysiology of Brain Inflammation, and Antimicrobial Treatments. (United States)

    Pugh, J Jeffrey; Levy, Rebecca A


    Primary amoebic meningoencephalitis (PAM) is a very rare disease with a high mortality rate. PAM is caused by Naegleria fowleri, an amoeba which resides in freshwater lakes and ponds and can survive in inadequately chlorinated pools ( Lopez, C.; Budge, P.; Chen, J., et al. Primary amebic meningoencephalitis: a case report and literature review . Pediatr. Emerg. Care 2012 , 28 , 272 - 276 ). In the past 50 years, there have been over 130 cases of Naegleria induced PAM in the United States with only three known survivors; one survivor was diagnosed and treated at Arkansas Children's Hospital. Successful treatment of PAM started with a rapid diagnosis, extensive antimicrobial therapy including an investigational medication miltefosine, supportive care, an intraventricular shunt, and hypothermia. These treatments address different aspects of the disease process. Increased understanding of the diagnosis and treatment of PAM is important especially for patients who present with meningitis-like findings during the summer months.

  7. Exosomes: A Novel Strategy for Treatment and Prevention of Diseases

    Directory of Open Access Journals (Sweden)

    Jiaqi Wang


    Full Text Available An “exosome” is a nanoscale membrane vesicle derived from cell endocytosis that functions as an important intercellular communication mediator regulating the exchange of proteins and genetic materials between donor and surrounding cells. Exosomes secreted by normal and cancer cells participate in tumor initiation, progression, invasion, and metastasis. Furthermore, immune cells and cancer cells exert a two-way bidirectional regulatory effect on tumor immunity by exchanging exosomes. Current studies on exosomes have further expanded their known functions in physiological and pathological processes. The purpose of this review is to describe their discovery and biological functions in the context of their enormous potential in the clinical diagnosis, prevention, and treatment of cancer as well as bacterial and viral infectious diseases.

  8. Genetic predisposition to colorectal cancer: Implications for treatment and prevention. (United States)

    Stoffel, Elena M; Yurgelun, Matthew B


    Colorectal cancer (CRC) is the third most common cancer diagnosed in men and women and approximately 5% of cases are associated with identifiable germline mutations associated with hereditary cancer syndromes. Lifetime risks for CRC can approach 50%-80% for mutation carriers in the absence of endoscopic and/or surgical intervention, and early identification of at-risk individuals can guide clinical interventions for cancer prevention and treatment. Personal and family history and molecular phenotype of CRC tumors are used in determining which patients should be referred for clinical genetic evaluation. Outcomes of genetic testing performed using next-generation sequencing (NGS) multigene panels suggest there can be significant overlap in clinical features among the various hereditary cancer syndromes. This review summarizes new developments in diagnosis and management of patients with genetic predisposition to CRC. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Current trends and recent advances in diagnosis, therapy, and prevention of hepatocellular carcinoma. (United States)

    Wang, Chun-Hsiang; Wey, Keh-Cherng; Mo, Lein-Ray; Chang, Kuo-Kwan; Lin, Ruey-Chang; Kuo, Jen-Juan


    Hepatocellular carcinoma (HCC) has been one of the most fatal malignant tumors worldwide and its associated morbidity and mortality remain of significant concern. Based on in-depth reviews of serological diagnosis of HCC, in addition to AFP, there are other biomarkers: Lens culinaris agglutinin-reactive AFP (AFP-L3), des- carboxyprothrombin (DCP), tyrosine kinase with Ig and eprdermal growth factor (EGF) homology domains 2 (TIE2)-espressing monocytes (TEMs), glypican-3 (GPC3), Golgi protein 73 (GP73), interleukin-6 (IL-6), and squamous cell carcinoma antigen (SCCA) have been proposed as biomarkers for the early detection of HCC. The diagnosis of HCC is primarily based on noninvasive standard imaging methods, such as ultrasound (US), dynamic multiphasic multidetector-row CT (MDCT) and magnetic resonance imaging (MRI). Some experts advocate gadolinium diethyl-enetriamine pentaacetic acid (Gd-EOB-DTPA) MRI and contrast-enhanced US as the promising imaging madalities of choice. With regard to recent advancements in tissue markers, many cuting-edge technologies using genome-wide DNA microarrays, qRT-PCR, and proteomic and inmunostaining studies have been implemented in an attempt to identify markers for early diagnosis of HCC. Only less than half of HCC patients at initial diagnosis are at an early stage treatable with curative options: local ablation, surgical resection, or liver transplant. Transarterial chemoembolization (TACE) is considered the standard of care with palliation for intermediate stage HCC. Recent innovative procedures using drug-eluting-beads and radioembolization using Yttrium-90 may exhibit beneficial effects in HCC treatment. During the past few years, several molecular targeted agents have been evaluated in clinical trials in advanced HCC. Sorafenib is currently the only approved systemic treatment for HCC. It has been approved for the therapy of asymptomatic HCC patients with well-preserved liver function who are not candidates for potentially

  10. PIXE studies of osteoporosis preventive treatments

    International Nuclear Information System (INIS)

    Ynsa, M.D.; Pinheiro, T.; Ager, F.J.; Alves, L.C.; Millan, J.C.; Gomez-Zubelbia, M.A.; Respaldiza, M.A.


    Particle induced X-ray emission (PIXE) and nuclear microprobe (NMP) have been used in an exploratory work to study elemental alterations in tissues of experimental animals submitted to osteoporosis preventive treatments. Osteopathologies have been associated with several factors, such as hormonal disturbances, metabolic aberrations, low dietary Ca and vitamin D intake, excess of iron, among other possible factors. Hormonal treatments seem to be beneficial to the incorporation of Ca in bone but breast and endometrial cancers constitute significant side effects that cannot be ignored. Wistar female rats were used to test the effect of estrogen therapy in osteoporosis progression. The variations of elemental concentrations in uterus and the Ca content of femoral bones of ovariectomised rats under estrogen therapy were investigated. PIXE, Rutherford backscattering spectrometry and secondary electron microscopy techniques were applied for the characterisation of biological materials, with respect to morphology and trace element distribution determination. The increase of Ca and Fe concentrations in uterus and the variations for Ca distribution patterns in bone of rats submitted to estrogen therapy were the major features observed

  11. PIXE studies of osteoporosis preventive treatments

    Energy Technology Data Exchange (ETDEWEB)

    Ynsa, M.D. E-mail:; Pinheiro, T.; Ager, F.J.; Alves, L.C.; Millan, J.C.; Gomez-Zubelbia, M.A.; Respaldiza, M.A


    Particle induced X-ray emission (PIXE) and nuclear microprobe (NMP) have been used in an exploratory work to study elemental alterations in tissues of experimental animals submitted to osteoporosis preventive treatments. Osteopathologies have been associated with several factors, such as hormonal disturbances, metabolic aberrations, low dietary Ca and vitamin D intake, excess of iron, among other possible factors. Hormonal treatments seem to be beneficial to the incorporation of Ca in bone but breast and endometrial cancers constitute significant side effects that cannot be ignored. Wistar female rats were used to test the effect of estrogen therapy in osteoporosis progression. The variations of elemental concentrations in uterus and the Ca content of femoral bones of ovariectomised rats under estrogen therapy were investigated. PIXE, Rutherford backscattering spectrometry and secondary electron microscopy techniques were applied for the characterisation of biological materials, with respect to morphology and trace element distribution determination. The increase of Ca and Fe concentrations in uterus and the variations for Ca distribution patterns in bone of rats submitted to estrogen therapy were the major features observed.

  12. [Preventive prophylactic treatment in posttraumatic epilepsy]. (United States)

    Oliveros-Juste, A; Bertol, V; Oliveros-Cid, A

    Posttraumatic epilepsy (PTE) represents about 2 3% of all the etiologies of epilepsy. The so called early seizures , which appear in the first week after the traumatic brain injury (TBI), are related to the severity of the injury; they do not have an strictly epileptic mechanism, but they become a risk factor to the development of PTE. PTE appears in 5% of all the patients suffering from all TBI, and in 15 20% of the patients suffering from a severe TBI. However, the endpoint uses to be to use antiepileptic drugs (AEDs) as prophylactic treatment in all well established PTE. The efficacy of classic antiepileptic drugs (Phenobarbital, Phenytoin, Carbamazepine, Valproate acid) to control the kindling effect has not been confirmed yet as a prophylactic treatment for PTE. Prophylactic efficacy of other drugs, like lipid peroxidation inhibitors, neuroprotectors (especially antioxidants), glutamic receptor blockers, NMDA receptor blockers, and drugs that modulate apoptosis via caspasas inhibition; however, they constitute new ways of therapeutic investigation with a strong experimental basis. Our recommended therapeutic strategy is not to administrate AEDs indiscriminately, but analyzing risk factors, designing a careful prevention for late seizures using AEDs with proven efficacy in partial seizures and with the best achievable tolerability; being also attentive to the possible use of new drugs in the future, like lipid peroxidation inhibitors, and drugs designed to inhibit other excitotoxic, ionic or oxidative processes.

  13. Colonic diverticular disease. Treatment and prevention. (United States)

    Gargallo Puyuelo, Carla J; Sopeña, Federico; Lanas Arbeloa, Angel


    Diverticular disease represents the most common disease affecting the colon in the Western world. Most cases remain asymptomatic, but some others will have symptoms or develop complications. The aims of treatment in symptomatic uncomplicated diverticular disease are to prevent complications and reduce the frequency and intensity of symptoms. Fibre, probiotics, mesalazine, rifaximin and their combinations seem to be usually an effective therapy. In the uncomplicated diverticulitis, outpatient management is considered the optimal approach in the majority of patients, and oral antibiotics remain the mainstay of treatment. Admission to hospital and intravenous antibiotic are recommended only when the patient is unable to intake food orally, affected by severe comorbidity or does not improve. However, inpatient management and intravenous antibiotics are necessary in complicated diverticulitis. The role of surgery is also changing. Most diverticulitis-associated abscesses can be treated with antibiotics and/or percutaneous drainage and emergency surgery is considered only in patients with acute peritonitis. Finally, patient related factors, and not the number of recurrences, play the most important role in selecting recipients of elective surgery to avoid recurrences. Copyright © 2015 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  14. The non-dystrophic myotonias: molecular pathogenesis, diagnosis and treatment (United States)

    Matthews, E.; Fialho, D.; Tan, S. V.; Venance, S. L.; Cannon, S. C.; Sternberg, D.; Fontaine, B.; Amato, A. A.; Barohn, R. J.; Griggs, R. C.


    The non-dystrophic myotonias are an important group of skeletal muscle channelopathies electrophysiologically characterized by altered membrane excitability. Many distinct clinical phenotypes are now recognized and range in severity from severe neonatal myotonia with respiratory compromise through to milder late-onset myotonic muscle stiffness. Specific genetic mutations in the major skeletal muscle voltage gated chloride channel gene and in the voltage gated sodium channel gene are causative in most patients. Recent work has allowed more precise correlations between the genotype and the electrophysiological and clinical phenotype. The majority of patients with myotonia have either a primary or secondary loss of membrane chloride conductance predicted to result in reduction of the resting membrane potential. Causative mutations in the sodium channel gene result in an abnormal gain of sodium channel function that may show marked temperature dependence. Despite significant advances in the clinical, genetic and molecular pathophysiological understanding of these disorders, which we review here, there are important unresolved issues we address: (i) recent work suggests that specialized clinical neurophysiology can identify channel specific patterns and aid genetic diagnosis in many cases however, it is not yet clear if such techniques can be refined to predict the causative gene in all cases or even predict the precise genotype; (ii) although clinical experience indicates these patients can have significant progressive morbidity, the detailed natural history and determinants of morbidity have not been specifically studied in a prospective fashion; (iii) some patients develop myopathy, but its frequency, severity and possible response to treatment remains undetermined, furthermore, the pathophysiogical link between ion channel dysfunction and muscle degeneration is unknown; (iv) there is currently insufficient clinical trial evidence to recommend a standard treatment

  15. Pedophilia: the problem with diagnosis and limitations of CBT in treatment. (United States)

    Studer, Lea H; Aylwin, A Scott


    This paper asserts two main points. First, there is little reason to include pedophilia among the mental disorders of the Diagnostic and Statistical Manual (DSM). The diagnostic criteria as specified in the DSM-IV-TR (2000) are both over-inclusive in that all acts of child molestation warrant diagnosis, and under-inclusive in that individuals who have not acted upon, and who are not distressed by their sexual interest in children do not meet diagnostic criteria. On both sides of this debate there are problems. A diagnosis of pedophilia seems to "medicalize" an illegal behavior, or "criminalize" fantasy; depending on the diagnostic criteria used, or the use made of the diagnosis. Secondly, the typical CBT-based relapse prevention treatment for pedophilia, which represents current best practice, is reviewed. It is suggested that this, as a stand alone therapy, is suboptimal. CBT components are necessary but not sufficient for comprehensive therapy. It is imperative that process issues are given primacy in treatment programs. The common factors literature makes it clear that the therapeutic relationship is at least as potent a factor promoting change as the system or techniques that clinicians employ. Diagnosis per se is not required for adequate treatment of these individuals. For the CBT components, some offence specific information is required but that is a far cry from true diagnosis.

  16. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. (United States)

    Mitchell, Caroline; Prabhu, Malavika


    Pelvic inflammatory disease (PID) is characterized by infection and inflammation of the upper genital tract in women and can cause significant reproductive health sequelae for women. Although a definitive diagnosis of PID is made by laparoscopic visualization of inflamed, purulent fallopian tubes, PID is generally a clinical diagnosis and thus represents a diagnostic challenge. Therefore, diagnosis and treatment algorithms advise a high index of suspicion for PID in any woman of reproductive age with pelvic or abdominal pain. Antibiotic therapy should be started early, and given for an adequate period of time to reduce the risk of complications. Coverage for anaerobic organisms should be considered in most cases. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment

    DEFF Research Database (Denmark)

    Pedersen, Lars; Elers, Jimmi; Backer, Vibeke


    is essential when treating elite athletes. This article is aimed at physicians who diagnose and treat athletes with respiratory symptoms. It focuses on the pathogenesis of asthma and exercise-induced bronchoconstriction in elite athletes and how the diagnosis can be made. Furthermore, treatment of elite......Elite athletes have a high prevalence of asthma and exercise-induced bronchoconstriction. Although respiratory symptoms can be suggestive of asthma, the diagnosis of asthma in elite athletes cannot be based solely on the presence or absence of symptoms; diagnosis should be based on objective...... measurements, such as the eucapnic voluntary hyperpnea test or exercise test. When considering that not all respiratory symptoms are due to asthma, other diagnoses should be considered. Certain regulations apply to elite athletes who require asthma medication for asthma. Knowledge of these regulations...

  18. Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment

    DEFF Research Database (Denmark)

    Pedersen, Lars; Elers, Jimmi; Backer, Vibeke


    Elite athletes have a high prevalence of asthma and exercise-induced bronchoconstriction. Although respiratory symptoms can be suggestive of asthma, the diagnosis of asthma in elite athletes cannot be based solely on the presence or absence of symptoms; diagnosis should be based on objective...... measurements, such as the eucapnic voluntary hyperpnea test or exercise test. When considering that not all respiratory symptoms are due to asthma, other diagnoses should be considered. Certain regulations apply to elite athletes who require asthma medication for asthma. Knowledge of these regulations...... is essential when treating elite athletes. This article is aimed at physicians who diagnose and treat athletes with respiratory symptoms. It focuses on the pathogenesis of asthma and exercise-induced bronchoconstriction in elite athletes and how the diagnosis can be made. Furthermore, treatment of elite...

  19. Pertussis: Topical issues of epidemiology, diagnosis, and prevention

    Directory of Open Access Journals (Sweden)

    I. V. Nikolaeva


    Full Text Available Despite widespread vaccination, pertussis remains an important cause of infant morbidity and mortality. About 16 million people are ill with this disease and approximately 195 thousand children die worldwide every year. However, only 5—10% of all pertussis cases are diagnosed and notified. In spite of wide immunization coverage, there is really a pertussis epidemic in many countries of the world now; moreover, vaccinated children constitute a high proportion of disease cases. Adolescents and adults are a major reservoir for cyclic outbreaks of pertussis; however, they are rarely diagnosed with the disease. The review gives scientists' opinion on the causes of this phenomenon and proposed measures to reduce morbidity in different age groups. The severe and complicated forms of pertussis and fatal outcomes occur in babies during the first months of life and therefore current vaccination strategies should be aimed at preventing the infection just in this age group of children.

  20. Vascular anomalies: A pictorial review of nomenclature, diagnosis and treatment (United States)

    Nosher, John L; Murillo, Philip G; Liszewski, Mark; Gendel, Vyacheslav; Gribbin, Christopher E


    Vascular anomalies, including vascular malformations and tumors, are frequently straightforward to detect; however, accurate diagnosis and appropriate treatment are often challenging. Misdiagnosis of these lesions can lead clinicians in the wrong direction when treating these patients, which can have unfavorable results. This review presents an overview of the classification systems that have been developed for the diagnosis of vascular lesions with a focus on the imaging characteristics. Pictorial examples of each lesion on physical examination, as well as non-invasive and minimally invasive imaging are presented. An overview of the endovascular treatment of these lesions is also given. In some cases, vascular anomalies may be associated with an underlying syndrome and several of the most commonly encountered syndromes are discussed. Understanding of the classification systems, familiarity with the treatment options and knowledge of the associated syndromes are essential for all physicians working with this patient population. The approach to the described entities necessitates an organized multi-disciplinary team effort, with diagnostic imaging playing an increasingly important role in the proper diagnosis and a combined interventional radiologic and surgical treatment method showing promising results. PMID:25276311

  1. Diagnosis and treatments of Prader-Willi syndrome: a review of current consensuses

    Directory of Open Access Journals (Sweden)

    Alisa Vital'evna Vitebskaya


    Full Text Available We analyzed international consensuses of experts and clinical recommendations on diagnosis and treatment of Prader-Willi syndrome (PWS: PWS consensus diagnostic criteria (1993; US PWS Association (PWSA-USA consensus statements on evaluating of breathing abnormalities (2007, osteoporosis (2008, growth hormone treatment in PWS (2000 and 2009; Endocrine society clinical practice guideline on Prevention and treatment of pediatric obesity (2008; the Second Expert Meeting of the Comprehensive Care of Patients with PWS Consensus published as Recommendations for the diagnosis and management of PWS (2008. Historical analysis and comparison of recommendations are presented in this review article. Absence of Russian clinical practice guidelines on PWS patients management makes necessary the detailed study of listed documents.

  2. Anxiety symptoms prior to a prostate cancer diagnosis: Associations with knowledge and openness to treatment. (United States)

    Dillard, Amanda J; Scherer, Laura D; Ubel, Peter A; Alexander, Stewart; Fagerlin, Angela


    Research suggests that anxiety may be a common response to a cancer diagnosis, but research is needed to examine anxiety before diagnosis. Anxiety before diagnosis may relate to the comprehension of relevant health information or openness to potential treatments. This study examined anxiety and these outcomes in men who were waiting to learn of a prostate cancer diagnosis. One goal of this study was to determine whether anxiety would increase as men came closer to learning the results of their prostate cancer biopsy. Another goal was to test whether anxiety was associated with knowledge about prostate cancer or openness to different treatments. Men (N = 265) who were facing a prostate cancer diagnosis were surveyed at two time points. Time 1 occurred at the time of biopsy, and Time 2 occurred immediately before men received their biopsy result. At each time point, men reported their anxiety about prostate cancer and their biopsy result. At Time 2, they completed a knowledge test of information about prostate cancer and reported their openness to different potential treatments. Anxiety symptoms increased as men came closer to learning their diagnosis. Also, higher anxiety was associated with lower knowledge and greater openness to particular treatments like surgery. Interactions showed that when anxiety increased from Time 1 to Time 2, having high or low knowledge mattered less to treatment openness. Waiting for a cancer diagnosis is an important time period in which anxiety may increase and relate to information processing and openness to treatments. Statement of contribution What is already known on this subject? Men undergoing prostate cancer screening have been found to experience high and low levels of anxiety. Research has shown that negative emotions like anxiety are common following a cancer diagnosis, but little research has examined emotions right before diagnosis. Anxiety has been associated with information processing and motivation to engage in

  3. Recommendations for the diagnosis of human papilloma virus (HPV) high and low risk in the prevention and treatment of diseases of the oral cavity, pharynx and larynx. Guide of experts PTORL and KIDL. (United States)

    Wierzbicka, Małgorzata; Józefiak, Agata; Szydłowski, Jarosław; Marszałek, Andrzej; Stankiewicz, Czesław; Hassman-Poznańska, Elżbieta; Osuch-Wójcikiewicz, Ewa; Składzień, Jacek; Klatka, Janusz; Pietruszewska, Wioletta; Puacz, Elżbieta; Szyfter, Krzysztof; Szyfter, Witold


    The role of human papilloma viruses (HPV) in malignant and nonmalignant ENT diseases and the corresponding epidemiological burden has been widely described. International head and neck oncology community discussed growing evidence that oral HPV infection contributes to the risk of oro-pharyngeal carcinoma (OPC) and recommended HPV testing as a part of the work up for patients with OPC. Polish Society of ENT Head Neck Surgery and National Chamber of Laboratory Diagnosticians have worked together to define the minimum requirements for assigning a diagnosis of HPV-related conditions and testing strategy that include HPV specific tests in our country. This paper briefly frames the literature information concerning low risk (LR) and high risk (HR) HPV, reviews the epidemiology, general guidance on the most appropriate biomarkers for clinical assessment of HPV. The definition of HPV-related cancer was presented. The article is aiming to highlight some of major issues for the clinician dealing with patients with HPV-related morbidities and to introduce the diagnostic algorithm in Poland. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

  4. Acute Severe Thallium Poisoning: Early Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    G. A. Livanov


    Full Text Available The paper considers the problems of diagnosis of severe thallium salt poisoning in early-stage intoxication, which are associated with the fact that alopecia, a clinical typical symptom of thallium toxicity, appears in the period exceeding two weeks. At the same time, in severe poisoning a fatal outcome occurs much more early and the first signs of intoxication are highly diversified and nonspecific. The clinical manifestations with no specificity at the early period of intoxication in conjunction with the absence of certain history data result in late (sometimes postmortem diagnosis in the vast majority of cases, particularly, in criminal cases. This comprises a danger of acute severe thallium poisoning since unrecognized intoxication leads to incorrect treatment and patient death. While making a differential diagnosis, attention should be given to a set of a number of symptoms that arouse suspicion of thallium poisoning, which is an indication for chemical and analytical studies of biological environments in these patients. This paper summarizes the available data on ethyology, pathogenesis and cliniu-cal manifestations of severe thallium poisoning and demonstrate own cases of thallium intoxication occurred recently in Yaroslavl and Saint Petersburg. Basic strategy of thallium poisoning treatment is presented and discussed. Key words: acute poisoning, thallium compounds, antidote therapy, diffeferential diagnosis.

  5. Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Petkova Aneta S.


    Full Text Available Spontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one or more adjacent vertebral bodies (spondylitis, the intervertebral discs (discitis and finally - the neighboring neural structures. In most cases the condition is due to a hematogenous infection and can affect all regions of the spinal cord, but it is usually localized in the lumbar area. The most common clinical symptom is a pronounced, constant and increasing nocturnal paravertebral pain, while consequently different degrees of residual neurological symptoms from nerve roots and/or spinal cord may appear. The disease course is chronic and the lack of specific symptoms often prolongs the time between its debut and the diagnosis. This delay in diagnosis determines its potentially high morbidity and mortality. Treatment is conservative in cases with no residual neurological symptoms and consists of antibiotic therapy and immobilization. Surgical treatment is necessary in patients with neurological deficit, spinal instability or drug resistance.

  6. [Differential diagnosis of treatment of episcleritis and scleritis]. (United States)

    Vorob'eva, O K; Razumova, I Iu; Ambartsumian, A R


    The purpose of the present investigation was to develop an optimal approach to rehabilitating patients with episcleritis and scleritis of various etiology. The paper summarizes the results of examination and treatment in 128 patients (142 eyes) with the acute chronic course of the diseases. To specify the etiopathogenesis of a disease, the patients were examined by a rheumatologist, an immunologist, a virologist, a phthisiatrician, an ENT specialist, and a roentgenologist. Rhinofrequency ultrasound biomicroscopy was made in the diagnosis of scleral inflammatory diseases. Ultrasound studies (ultrasound biomicroscopy and B-scanning of the eye) were additionally conducted. Complex therapy produced a marked positive clinical effect in 124 patients (138 eyes). During 5 years, immunological parameters improved in all the examined. Thus, episcleritis and scleritis are an overall immunological disorder and frequently associated with infections. Current laboratory clinical and instrumental studies considerably enhance the efficiency of the diagnosis and, hence, treatment of these diseases.

  7. Pulmonary arterial hypertension: an update on diagnosis and treatment. (United States)

    Stringham, Richard; Shah, Nipa R


    Pulmonary arterial hypertension is defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest or 30 mm Hg during physical activity. Pulmonary arterial hypertension is classified into subgroups, including idiopathic, heritable, and pulmonary arterial hypertension associated with other conditions. A detailed history, thorough physical examination, and most importantly, a high index of suspicion are essential to diagnosis. Evaluation includes echocardiography and exclusion of other causes of symptoms. Targeted laboratory testing can help identify the subgroup of pulmonary arterial hypertension. Right heart catheterization is required to confirm the diagnosis. Standard treatment options include oral anticoagulation, diuretics, oxygen supplementation, and for a small percentage of patients, calcium channel blockers. Newer treatments include prostacyclin analogues, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. Combination therapy has been shown to improve pulmonary arterial pressure, but more research is needed. Interventional procedures for patients with pulmonary arterial hypertension include balloon atrial septostomy and lung transplantation.

  8. Diagnosis and Treatment of Drug-Resistant Tuberculosis. (United States)

    Caminero, José A; Cayla, Joan A; García-García, José-María; García-Pérez, Francisco J; Palacios, Juan J; Ruiz-Manzano, Juan


    In the last 2 decades, drug-resistant tuberculosis has become a threat and a challenge to worldwide public health. The diagnosis and treatment of these forms of tuberculosis are much more complex and prognosis clearly worsens as the resistance pattern intensifies. Nevertheless, it is important to remember that with the appropriatesystematic clinical management, most of these patients can be cured. These guidelines itemize the basis for the diagnosis and treatment of all tuberculosis patients, from those infected by strains that are sensitive to all drugs, to those who are extensively drug-resistant. Specific recommendations are given forall cases. The current and future role of new molecular methods for detecting resistance, shorter multi-drug-resistant tuberculosis regimens, and new drugs with activity against Mycobacterium tuberculosis are also addressed. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Diagnosis, prevention and management of postoperative pulmonary edema. (United States)

    Bajwa, Sj Singh; Kulshrestha, A


    Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central),,,,, Scopus, Science Direct,, and Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

  10. Enterobacteriaceae infection – diagnosis, antibiotic resistance and prevention

    Directory of Open Access Journals (Sweden)

    Anna Jarząb


    Full Text Available Intestinal infections caused by rod-shaped bacteria of the [i]Enterobacteriaceae[/i] genus are one of the major health hazards in countries where sanitation standards are low. [i]Strains[/i] of [i]Shigella,[/i] [i]Salmonella, Escherichia[/i] and [i]Yersinia [/i]are responsible for diarrhea, severe bacillary dysentery, typhoid, other intestinal diseases, as well as genitourinary tract and blood infections. According to the WHO there are 4.5 billion cases every year, of which 1.9 million end in death. This makes intestinal infections third in terms of human disease mortality. In this work we discuss methods of pathogen identification, the mechanism of host-pathogen interaction, and the nature of the ¬host’s immunological response. Due to rising drug resistance we discuss the importance of better pathogen detection, vaccine design and the use of vaccines as a preventive measure against intestinal infections. Special attention is paid to OMP38, a protein isolated from [i]S. flexneri[/i] 3a outer membrane. Since it is known that this protein has good immunogenic properties, it can be used as an antigen or carrier for conjugate vaccines.

  11. Costs of providing tuberculosis diagnosis and treatment services in Viet Nam. (United States)

    Minh, H V; Mai, V Q; Nhung, N V; Hoi, L V; Giang, K B; Chung, L H; Kien, V D; Duyen, N T; Ngoc, N B; Anh, T T; Phuong, T B; Ngan, T T; Khanh, P H


    To estimate the cost of providing tuberculosis (TB) diagnosis and treatment packages at different levels of health facilities in Viet Nam. This was a retrospective costing study from the providers' perspective using a standard costing approach. We included typical services for TB diagnosis and treatment based on standard protocols. The least expensive TB service was the 6-month isoniazid preventive therapy regimen for latent tuberculous infection provided by district health centres (US$7.20-14.30, accounting for 0.3-0.7% of Viet Nam's per capita gross domestic product [GDP] of US$2052.30 in 2014). The cost of diagnosing and treating a patient with drug-susceptible TB (the most common type of TB) ranged between US$51.20 and US$180.70, and represented 2.5-8.8% of Viet Nam's per capita GDP in 2014. The most expensive TB service was the diagnosis and treatment of a multidrug-resistant TB case (US$1568.20-2391.20), accounting for 76.4-116.5% of Viet Nam's per capita GDP in 2014). The cost of TB diagnosis and treatment services in Viet Nam varied according to level of health facility, type of TB, different costing options, and different staff cost scenarios.

  12. European guideline for the diagnosis and treatment of insomnia


    Riemann, Dieter; Baglioni, Chiara; Bassetti, Claudio; Bjorvatn, Bjorn; Groselj, Leja Dolenc; Ellis, Jason G.; Espie, Colin A.; Garcia-Borreguero, Diego; Gjerstad, Michaela; Goncalves, Marta; Hertenstein, Elisabeth; Jansson-Frojmark, Markus; Jennum, Poul J.; Leger, Damien; Nissen, Christoph


    Abstract: This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes ad...

  13. Cracked tooth diagnosis and treatment: An alternative paradigm


    Mamoun, John S.; Napoletano, Donato


    This article reviews the diagnosis and treatment of cracked teeth, and explores common clinical examples of cracked teeth, such as cusp fractures, fractures into tooth furcations, and root fractures. This article provides alternative definitions of terms such as cracked teeth, complete and incomplete fractures and crack lines, and explores the scientific rationale for dental terminology commonly used to describe cracked teeth, such as cracked tooth syndrome, structural versus nonstructural cr...

  14. Aceruloplasminemia: a rare disease - diagnosis and treatment of two cases

    Directory of Open Access Journals (Sweden)

    Maria do Rosário Ferraz Roberti


    Full Text Available Aceruloplasminemia is a rare autosomal recessive disease in which a mutation leads to the absence or dysfunction of ceruloplasmin. Deficiency of this enzyme leads to the accumulation of iron in various organs; aceruloplasminemia is usually characterized by diabetes, retinal degeneration and neurological disorders. Diagnosis is suspected by the presence of elevated levels of ferritin, anemia, decreased serum copper and absence of ceruloplasmin in serum. Treatment of aceruloplasminemia is mainly based on the control of iron overload.

  15. Treatment and prevention of music performance anxiety. (United States)

    Spahn, Claudia


    Music performance anxiety (MPA) regularly occurs when musicians present themselves before an audience in performance situations, and thus, it plays an important role in the careers of professional musicians. MPA is expressed on the emotional and physical level, as well as on the levels of thinking and behavior, and extends along a continuum of varying severity. Its performance-impairing, afflicting form is considered to be a specific type of social phobia, which requires therapy. There are different psychological theories, which contribute to the understanding of the phenomenon of MPA and provide basic principles for the various treatment approaches. Current "best practice," in our clinical experience, is a personal- and problem-oriented approach within a multimodal therapy model, including the range of psychoanalytic and cognitive behavioral therapies, body-oriented methods, and mental techniques. In order to avoid severe MPA, prevention in the field of music pedagogic is very important. Thus, the concepts of dealing positively with MPA should be implemented very early into the instrumental and vocal education of musicians. © 2015 Elsevier B.V. All rights reserved.

  16. Diagnosis and successful medical treatment of Acanthamoeba keratitis. (United States)

    D'Aversa, G; Stern, G A; Driebe, W T


    To identify the methods that result in timely diagnosis and effective treatment of Acanthamoeba keratitis. We retrospectively reviewed the medical records of 12 consecutive patients whom we treated for culture-proved Acanthamoeba keratitis in 14 eyes. Contact lenses were worn in 13 of 14 affected eyes and substandard methods were often used to care for them. The diagnosis was established in all patients by laboratory analysis of corneal scrapings; corneal biopsies were not required. Acanthamoeba organisms were identified on smears from 12 of 14 eyes with use of standard, nonfluorescent stains and recovered in culture from all patients by inoculating scrapings on nonnutrient agar overlaid with Escherichia coli. Eleven of 14 eyes were medically cured with a combination of antiamebic drugs, most commonly propamidine isethionate, neomycin sulfate, and clotrimazole. Topical corticosteroids were used in only one patient. Two of the three eyes that required therapeutic keratoplasty were not treated before surgery according to our usual protocol; the third required keratoplasty for treatment of a severe bacterial superinfection. Twelve of 14 eyes recovered 20/50 or better visual acuity. Bacterial superinfections were a serious problem, with a total of six superinfections occurring in three treated eyes. With timely diagnosis and medical treatment with a combination of antiamebic drugs and avoidance of topical corticosteroids, most cases of Acanthamoeba keratitis can be cured, with an excellent prognosis for visual recovery.

  17. [Diagnosis, treatment, and follow-up of cesarean scar pregnancy]. (United States)

    Nguyen-Xuan, H-T; Lousquy, R; Barranger, E


    Cesarean scar pregnancy is a rare entity. This situation may induce uterine rupture and/or a massive life-threatening hemorrhage. The standard treatment is laparotomy surgery, but in situ injections to replace invasive surgery. The objective of this study was to focus on the diagnosis, optimal management and long-term follow-up of the patients. Data from 6 patients with diagnosis of cesarean scar pregnancy between 2007 and 2013 at Lariboisière hospital were retrospectively collected. Endovaginal ultrasound succeeded to diagnose all cases. Four patients were treated with in situ injection of methotrexate performing a vaginal way (n=2) or laparoscopy (n=2) and two others using systemic injection. One patient was complicated by hemorrhagic shock requiring iterative embolizations. Three patients achieved a new pregnancy, with one recurrent scar pregnancy complicated by massive hemorrhage. Diagnosis and treatment of cesarean scar pregnancies must be done precociously because of high hemorrhage risks. Endovaginal ultrasound is the gold standard exam. Treatment is non-consensual, but methotrexate in situ injection is effective and safer. Monitoring the decrease of HCG levels and ultrasonography supervision of gestational sac size and its vascularization must be performed. Due to the risk of recurrence, any subsequent pregnancy shows a high risk of complications. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Arab American women's lived experience with early-stage breast cancer diagnosis and surgical treatment. (United States)

    Obeidat, Rana Fakhri; Lally, Robin M; Dickerson, Suzanne S


    Currently, limited literature addresses Arab American women's responses to the impact of breast cancer and its treatments. The objective of the study was to understand the experience of being diagnosed with and undergoing surgical treatment for early-stage breast cancer among Arab American women. A qualitative interpretive phenomenological research design was used for this study. A purposive sample of 10 Arab American women who were surgically treated for early-stage breast cancer in the United States was recruited. Data were collected using individual interviews and analyzed using the Heideggerian hermeneutical methodology. Arab American women accepted breast cancer diagnosis as something in God's hands that they had no control over. Although they were content with God's will, the women believed that the diagnosis was a challenge that they should confront. The women confronted this challenge by accessing the healthcare system for treatment, putting trust in their physicians, participating when able in treatment decisions, using religious practices for coping, maintaining a positive attitude toward the diagnosis and the treatment, and seeking information. Arab American women's fatalistic beliefs did not prevent them from seeking care and desiring treatment information and options when diagnosed with breast cancer. It is important that healthcare providers encourage patients to express meanings they attribute to their illness to provide them with appropriate supportive interventions. They should also individually assess patients' decision-making preferences, invite them to participate in decision making, and provide them with tailored means necessary for such participation without making any assumptions based on patients' ethnic/cultural background.

  19. Pediatric obesity: Causes, symptoms, prevention and treatment. (United States)

    Xu, Shumei; Xue, Ying


    , and mitochondrial uncoupling proteins, are known to affect body weight. These molecules serve as potential targets for the pharmacological manipulation of obesity. Sibutramine and orlistat are primariliy used for the treatment of adult obesity, which produces modest weight loss, of 3-8% compared to placebo. For children and obese adolescents, metformin is used in the case of insulin resistance and hyperinsulinemia. Octreotide is used for hypothalamic obesity. Bariatric surgery is performed for the treatment of severe childhood obesity. The causes, symptoms, prevention and treatment of pediatric obesity are described in the present review.

  20. Challenges With the Diagnosis and Treatment of Cerebral Radiation Necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Chao, Samuel T., E-mail: [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Ahluwalia, Manmeet S. [Department of Medical Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Barnett, Gene H. [Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Stevens, Glen H.J. [Department of Neurology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Murphy, Erin S. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Stockham, Abigail L. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Shiue, Kevin [Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Suh, John H. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States)


    The incidence of radiation necrosis has increased secondary to greater use of combined modality therapy for brain tumors and stereotactic radiosurgery. Given that its characteristics on standard imaging are no different that tumor recurrence, it is difficult to diagnose without use of more sophisticated imaging and nuclear medicine scans, although the accuracy of such scans is controversial. Historically, treatment had been limited to steroids, hyperbaric oxygen, anticoagulants, and surgical resection. A recent prospective randomized study has confirmed the efficacy of bevacizumab in treating radiation necrosis. Novel therapies include using focused interstitial laser thermal therapy. This article will review the diagnosis and treatment of radiation necrosis.

  1. Impact of health education on home treatment and prevention

    African Journals Online (AJOL)

    Emmanuel Ameh

    Impact of health education on home treatment and prevention of malaria. Chirdan O. O. et al. Page | 115 taken at home and dangers of self treatment. Part 3: Treatment of uncomplicated malaria and prevention of malaria. Posters and chloroquine drug charts were used as teaching aids. Post intervention impact assessment.

  2. Prevention of relapse in generalized anxiety disorder by escitalopram treatment. (United States)

    Allgulander, Christer; Florea, Ioana; Huusom, Anna K Trap


    Escitalopram has demonstrated a robust and dose-dependent efficacy in the treatment of generalized anxiety disorder (GAD) for up to 3 months. In the present study, the efficacy and tolerability of escitalopram in the prevention of relapse in GAD was investigated. A total of 491 patients with a primary diagnosis of GAD and a Hamilton Anxiety (HAMA) total score>or=20 received 12 wk of open-label treatment with a fixed dose of escitalopram (20 mg/d). Of these, 375 patients responded (HAMA total scoretreatment with 20 mg/d escitalopram (n=187) or placebo (n=188). Treatment was continued for 24-76 wk unless the patient relapsed or was withdrawn for other reasons. Relapse was defined as either an increase in HAMA total score to >or=15, or lack of efficacy, as judged by the investigator. The results of the primary analysis showed a clear beneficial effect of escitalopram relative to placebo on the time to relapse of GAD (log-rank test, pinsomnia (2-6%). Escitalopram 20 mg/d significantly reduced the risk of relapse and was well tolerated in patients with GAD.

  3. Post-traumatic impaction of maxillary incisors: diagnosis and treatment. (United States)

    Paoloni, Valeria; Pavoni, Chiara; Mucedero, Manuela; Bollero, Patrizio; Laganà, Giuseppina; Cozza, Paola


    To provide clinicians with useful information for immediate diagnosis and management of impacted maxillary incisors due to trauma. We present a case of post-traumatic impaction of a central right maxillary incisor in a young patient. The treatment plan consisted in the interceptive management (surgical and orthodontic), the valuation of the necessary space to move the impacted tooth in the normal position and the biomechanical approach for anchorage, avoiding prosthetic/implants replacement. THE THERAPY OF AN IMPACTED MAXILLARY INCISOR DUE TO TRAUMA REQUIRES A MULTIDISCIPLINARY APPROACH: orthodontic, surgical, endodontic and periodontal considerations are essential for successful treatment. SURGICAL EXPOSURE AND ORTHODONTIC TRACTION IS THE TREATMENT MOST OFTEN USED IN CASE OF POSTTRAUMATIC IMPACTED INCISOR: this technique in fact can lead to suitable results at the periodontal, occlusal and esthetics levels at an early stage and more definitively than with other treatment options.

  4. Rare genetic diseases: update on diagnosis, treatment and online resources. (United States)

    Pogue, Robert E; Cavalcanti, Denise P; Shanker, Shreya; Andrade, Rosangela V; Aguiar, Lana R; de Carvalho, Juliana L; Costa, Fabrício F


    Rare genetic diseases collectively impact a significant portion of the world's population. For many diseases there is limited information available, and clinicians can find difficulty in differentiating between clinically similar conditions. This leads to problems in genetic counseling and patient treatment. The biomedical market is affected because pharmaceutical and biotechnology industries do not see advantages in addressing rare disease treatments, or because the cost of the treatments is too high. By contrast, technological advances including DNA sequencing and analysis, together with computer-aided tools and online resources, are allowing a more thorough understanding of rare disorders. Here, we discuss how the collection of various types of information together with the use of new technologies is facilitating diagnosis and, consequently, treatment of rare diseases. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Developments and challenges in the diagnosis and treatment of ADHD

    Directory of Open Access Journals (Sweden)

    Taciana G. Costa Dias


    Full Text Available Attention-deficit/hyperactivity disorder (ADHD is a prevalent neurodevelopmental disorder, often associated with other psychiatric comorbidities, functional impairments, and poor long-term outcomes. The objective of this selected review is to describe current advances and challenges in the diagnosis and treatment of ADHD. The disorder is associated with neurobiological underpinnings and is highly heterogeneous in various aspects, such as symptom profiles, cognitive impairments, and neurobiological and genetic features. The efficacy and safety of short-term pharmacological treatments across the life cycle is well studied, but further research investigating long-term treatment, impact of treatment in preschoolers, and non-pharmacological interventions is needed. Future research is also needed to better characterize the neurodevelopmental pathways of the disorder, linking clinical and neurobiological information, less investigated populations, and new interventions.

  6. Diagnosis and treatment characteristics of radioactive optic neuropathy

    Directory of Open Access Journals (Sweden)

    Yan Zhang


    Full Text Available AIM: To explore the diagnosis and treatment methods of radioaction-induced optic neuritis(RIONthrough the clinical dates of 17 patients. METHODS: It was a retrospective case series study. From August 2008 to October 2013, 17 cases(24 eyesof Rion clinical dates from Chinese PLA General Hospital were studied. The diagnosis methods including visual acuity, pupil, fundus, visual field, fundus fluorescein angiography(FFA, visual electrophysiological testing, and head MRI. To analysis the clinical date of patients with diagnosis of RION by statistical description.RESULTS: The deterioration degree of vision: 13 eyes were classified as Ⅳ, 9 eyes as Ⅲ, 2 eyes as Ⅱ. Ten eyes RAPD(+, visual electrophysiology is extinguished. The retina of 5 eyes showed flame hemorrhages and cotton wool spots exudation. Optic nerve head edema in one eye. T1-weighted MRI enhanced in 19 eyes which showed optic nerve of the intracranial and intratubal segments abnormal changed, optic chiasm and pituitary stalk signal abnormalities and enhancement of the optic nerve. Tortuous optic nerves and rough edges were observed in 5 eyes. Treatment effect: 4 eyes of visual acuity improved, 1 eye from blindness to light perception,1 eye from 0.08 to 0.2, 1 eye from 0.4 to 0.6,1 eye from 0.04 to 0.15, the rest of the cases did not see any improvement.CONCLUSION: The unique clinical manifestation of RION can provide objective basis for clinical diagnosis in time, but there have not been proven any effective treatments.

  7. Epithelial borderline ovarian tumor: Diagnosis and treatment strategy. (United States)

    Ushijima, Kimio; Kawano, Kouichiro; Tsuda, Naotake; Nishio, Shin; Terada, Atsumu; Kato, Hiroyuki; Tasaki, Kazuto; Matsukuma, Ken


    Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of "borderline tumor". It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.

  8. UK clinical guideline for the prevention and treatment of osteoporosis. (United States)

    Compston, J; Cooper, A; Cooper, C; Gittoes, N; Gregson, C; Harvey, N; Hope, S; Kanis, J A; McCloskey, E V; Poole, K E S; Reid, D M; Selby, P; Thompson, F; Thurston, A; Vine, N


    In 2008, the UK National Osteoporosis Guideline Group (NOGG) produced a guideline on the prevention and treatment of osteoporosis, with an update in 2013. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over. Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment, lifestyle measures and pharmacological interventions, duration and monitoring of bisphosphonate therapy, glucocorticoid-induced osteoporosis, osteoporosis in men, postfracture care and intervention thresholds. The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management.

  9. Diagnosis and treatment of radioactive poisoning. Proceedings of the scientific meeting on the diagnosis and treatment of radioactive poisoning

    International Nuclear Information System (INIS)


    The increasing use of atomic energy generated by nuclear fission is necessarily accompanied by the production of large quantities of radioactive isotopes. This, together with the growing use of radioactive materials in many fields, has given added importance to practical considerations of how best to deal with accidents - should they occur - involving radioactive contamination of individuals. Such considerations require knowledge of the metabolic behaviour of various radionuclides in man and of methods of increasing their elimination from the body. Information of this type is limited, and it is therefore essential to make maximum use of those data which, are available. Analyses of earlier accidents are one important source of such data; another is experience gained from the medical administration of radioisotopes for therapeutic or diagnostic purposes. The World Health Organization and the International Atomic Energy Agency jointly sponsored a scientific meeting on the Diagnosis and Treatment of Radioactive Poisoning, in Vienna from 15 to 18 October 1962. The aim of the meeting, which followed an earlier one (The Diagnosis and Treatment of Acute Radiation Injury) sponsored by the two organizations in 1960 on another aspect of radiation protection, was to review the present state of knowledge on the diagnosis, evaluation and treatment of persons who have accidentally incorporated radioactive materials. It brought together three groups of persons: those experienced in various methods of diagnosis and treatment of patients who have been exposed (occupationally or accidentally) to radioactive material; those engaged in the clinical administration of radionuclides and the study of their behaviour in man; and those working on related problems with experimental animals. In view of the great interest of many of the topics discussed at the meeting, it was felt desirable that the information presented in the papers and brought out in the ensuing discussions should be

  10. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. (United States)

    Durvasula, Ramani; Miller, Theodore R


    Clinical management of HIV must account for the "triple diagnosis" of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990s, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention.

  11. Diagnosis and treatment of interstitial cystitis in adolescents. (United States)

    Yoost, J L; Hertweck, S P; Loveless, M


    Interstitial cystitis (IC), or painful bladder syndrome, is characterized by irritative voiding symptoms and can be a challenging problem that affects children and adolescents. Diagnosis and management in children and adolescents is challenging because of strict diagnostic criteria and the paucity of investigations focusing on this age group, which often can lead to delayed or missed diagnosis. Clinical features suggestive of IC include bladder pain, urgency, frequency, nocturia, and pressure. Symptoms may wax and wane and often are exacerbated by menstruation, intercourse, dietary triggers, and stress. Diagnosis can be made by history, physical exam findings such as suprapubic tenderness, voiding diaries, and exclusion of other etiologies. Some diagnostic tests such as the potassium sensitivity test and cystoscopy are invasive and often impractical in younger patients. Treatment of IC consists of a multimodal approach that should be tailored to the individual needs of the patient. Therapies for younger patients include oral medication, intravesical therapy, cystoscopy with hydrodistention, and conservative measures such as dietary modification. This review of the literature focuses on diagnosing IC in younger patients and on what treatment modalities are appropriate and effective for this age group. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  12. Challenges in the diagnosis and treatment of pulmonary arterial hypertension.

    LENUS (Irish Health Repository)


    Advances in the diagnosis and management of pulmonary arterial hypertension (PAH) have resulted in significant improvements in outcomes for patients with this devastating and progressive disease. However, because of the non-specific nature of its symptoms, and the low level of suspicion among clinicians, prompt and accurate diagnosis of PAH as a rare disease remains a challenge. This article explains some of the issues that need to be addressed when faced with a patient with suspected PAH and describes how noninvasive and invasive techniques can be used effectively to ensure an accurate diagnosis. The availability of PAH-specific therapy means that once diagnosed, patients have a much greater chance of survival than they would have had in the past. However, despite improved survival, mortality is still high and, therefore, there is still room for improvement. It is currently recommended that patients with an inadequate clinical response to treatment receive sequential combination therapy; however, supportive data are still scarce. Although there is no clear explanation, these findings may be explained by the design and end-points chosen in clinical trials, the changing population of PAH and a need to improve the management strategy in this disease. Indeed, there is a clear need for randomised controlled studies that investigate whether adopting individualised treatment strategies, including upfront combination therapy, could help to optimise long-term management of patients with PAH.

  13. Diagnosis and treatment of hepatocellular carcinoma: An update (United States)

    Tejeda-Maldonado, Javier; García-Juárez, Ignacio; Aguirre-Valadez, Jonathan; González-Aguirre, Adrián; Vilatobá-Chapa, Mario; Armengol-Alonso, Alejandra; Escobar-Penagos, Francisco; Torre, Aldo; Sánchez-Ávila, Juan Francisco; Carrillo-Pérez, Diego Luis


    Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium “washout” in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and loco-regional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion’s stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib. PMID:25848464

  14. Pain in Fabry Disease: Practical Recommendations for Diagnosis and Treatment. (United States)

    Politei, Juan M; Bouhassira, Didier; Germain, Dominique P; Goizet, Cyril; Guerrero-Sola, Antonio; Hilz, Max J; Hutton, Elspeth J; Karaa, Amel; Liguori, Rocco; Üçeyler, Nurcan; Zeltzer, Lonnie K; Burlina, Alessandro


    Patients with Fabry disease (FD) characteristically develop peripheral neuropathy at an early age, with pain being a crucial symptom of underlying pathology. However, the diagnosis of pain is challenging due to the heterogeneous and nonspecific symptoms. Practical guidance on the diagnosis and management of pain in FD is needed. In 2014, experts met to discuss recent advances on this topic and update clinical guidance. Emerging disease-specific tools, including FabryScan, Fabry-specific Pediatric Health and Pain Questionnaire, and Würzburg Fabry Pain Questionnaire, and more general tools like the Total Symptom Score can aid diagnosis, characterization, and monitoring of pain in patients with FD. These tools can be complemented by more objective and quantifiable sensory testing. In male and female patients of any age, pain related to FD can be an early indication to start disease-specific enzyme replacement therapy before potentially irreversible organ damage to the kidneys, heart, or brain occurs. To improve treatment outcomes, pain should be diagnosed early in unrecognized or newly identified FD patients. Treatment should include: (a) enzyme replacement therapy controlling the progression of underlying pathology; (b) adjunctive, symptomatic pain management with analgesics for chronic neuropathic and acute nociceptive, and inflammatory or mixed pain; and (c) lifestyle modifications. © 2016 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.

  15. Thromboembolic Conditions, Aetiology Diagnosis and Treatment in Dogs and Cats

    Directory of Open Access Journals (Sweden)

    Filip Konečný


    Full Text Available In veterinary medicine, thrombo-embolism (TE is an under-appreciated medical condition that requires immediate recognition. Since TE is multifactorial and its mode of presentation may vary, veterinarians face great difficulties in making a definitive diagnosis in a timely manner. In addition, most of the underlying conditions that give rise to TE are life-threatening and an aggressive diagnostic and therapeutic approach is required. Not only does the diagnosis and treatment of this condition require the collaboration of many specialties, the costs of therapy can be excessive with a high risk of recurrence. As such, owners have to be thoroughly informed before the therapy commences. While TE has been well-characterized in humans and is associated with significant morbidity and mortality, little information of similar quality is available in veterinary medicine. In addition, TE in animals is distinct from its human counterpart and we cannot simply adapt what is known from human clinical trials. With the promise of improvements in imaging modalities that improve our diagnostic capabilities, the window of opportunity to treat TE increases. This article focuses on aetiology, clinical presentation, diagnosis, and treatment of dogs and cats affected by TE.

  16. Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office. (United States)

    Anderson, Kathryn L; Strowd, Lindsay C

    Scabies is a neglected skin disease, and little is known about current incidence and treatment patterns in the United States. The purpose of this study was to examine demographic data, treatment types, success of treatment, and misdiagnosis rate of scabies in an outpatient dermatology clinic. A retrospective chart review of patients diagnosed with scabies within the past 5 years was performed. A total of 459 charts were identified, with 428 meeting inclusion criteria. Demographic data, diagnostic method, treatment choice, misdiagnosis rate, treatment failure, and itching after scabies are also reported. Children were the largest age group diagnosed with scabies, at 38%. Males (54%) were diagnosed with scabies more than females. The majority of diagnoses were made by visualizing ova, feces, or mites on light microscopy (58%). At the time of diagnosis, 45% of patients had been misdiagnosed by another provider. Topical permethrin was the most common treatment used (69%), followed by a combination of topical permethrin and oral ivermectin (23%), oral ivermectin (7%), and other treatments (1%). Our findings suggest that more accurate and faster diagnostic methods are needed to limit unnecessary treatment and expedite appropriate therapy for scabies. © Copyright 2017 by the American Board of Family Medicine.

  17. Prevention: The Best Treatment for Back Pain (United States)

    ... of the top reasons for doctor visits. Back pain has many causes, including bad posture, excessive weight, poor workstation setup, lack of exercise and limited flexibility. Fortunately, many of them are preventable and ... can help prevent back pain. Depending on the cause, the pain can occur ...

  18. Prevention, Diagnosis and Treatment of Chemotherapy-Induced Cardiotoxicity: what Are we Doing about it? Prevención, diagnóstico y tratamiento de la cardiotoxicidad inducida por quimioterapia: ¿qué estamos haciendo?

    Directory of Open Access Journals (Sweden)

    Lázaro de la Cruz Avilés


    Full Text Available Heart disease and malignant tumors are the two leading causes of death in Cuba, with mortality rates of 197,5 and 193,6 per 100 000, respectively, in 2011. In Cienfuegos, malignant tumors were the leading cause of death with a rate of 115,2 followed by heart disease with 102,6 per 100 000 inhabitants. The improvements in the detection and treatment of cancer have led to a new cohort of patients achieving such a long survival that cardiac complications may appear. Unfortunately, the wide knowledge on biochemical pathways involved in cancer targeted therapy has not been accompanied by a parallel understanding of cardiac consequences of their modulation.Las enfermedades del corazón y los tumores malignos constituyen las dos primeras causas de muerte en Cuba, con tasas de mortalidad de 197,5 y 193,6 por 100 000 habitantes, respectivamente, en el año 2011. En Cienfuegos los tumores malignos fueron la primera causa de muerte con una tasa de 115,2 seguida de las enfermedades del corazón con 102,6 por 100 000 habitantes. Las mejoras alcanzadas en la detección y el tratamiento del cáncer han dado origen a una nueva cohorte de pacientes que alcanzan una supervivencia suficiente para que puedan aparecer complicaciones cardíacas derivadas del tratamiento. Lamentablemente, el abundante conocimiento sobre las vías bioquímicas involucradas en el tratamiento dirigido del cáncer no se ha visto acompañado de un conocimiento paralelo de las consecuencias cardíacas de su modulación.

  19. Oral lichen planus: A look from diagnosis to treatment.

    Directory of Open Access Journals (Sweden)

    Pablo Córdova


    Full Text Available Oral lichen planus (OLP is a chronic mucocutaneous disease of unknown etiology. Its pathogenesis is multifactorial and it may affect the oral mucosa, skin and other mucous membranes. Diagnosis is based on clinic and histopathology; direct immunofluorescence techniques can also be of use. It affects about one to two percent of the population, mainly women between the fifth and sixth decades of life. In the mouth, the most affected area is the buccal mucosa, followed by the gums, tongue and/or palate. Its three most representative clinical forms are reticular, erythematous and erosive; evolution depends on the type it is. Lesion treatment is determined by the clinical form and, since no fully effective treatment has been found yet, it is directed towards controlling the disease. The treatment of choice involves topical or systemic corticosteroids, but other drugs may also be used.The aim of this paper is to gather current and relevant information about oral lichen planus: its pathogenesis, diagnosis, treatment and management.

  20. Headache and facial pain: differential diagnosis and treatment. (United States)

    Bernstein, Jonathan A; Fox, Roger W; Martin, Vincent T; Lockey, Richard F


    Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. [Mental impairment in children with cerebral palsy: diagnosis and treatment]. (United States)

    Nemkova, S A


    The article covers the problems of diagnosis and treatment of mental impairment in children with cerebral palsy. Mental disorders in cerebral palsy include cognitive impairment (disorders of perception, memory, attention, motor-visual coordination, intelligence and speech), border disorders (cerebral/asthenic, neurosis-like, psychopathic-like syndromes) and personality disorders (accentuation of character, mental infantilism). Diagnosis of mental disorders in patients with cerebral palsy is a challenging task, due to various combinations of them with physical, speech and sensory disorders, which requires a differentiated approach. Current trends in comprehensive system of rehabilitation, including medical and social, and psychological-pedagogical correction of cognitive, emotional and behavioral disorders, in cerebral palsy are reviewed. Experience of using cortexin, which compensates for cognitive impairment and improves social adaptation, is discussed.

  2. Early diagnosis and treatment of DDH: a sonographic approach. (United States)

    De Pellegrin, M; Moharamzadeh, D; Fraschini, G


    This study reviews the data regarding clinical and ultrasound (US) examinations, collected during an 11-year period, in a DDH dedicated outpatient clinic. The material was analysed in order to verify the importance of US hip examination and Ortolani's test for early DDH diagnosis, to select dysplastic, unstable hips, to identify the role of the labrum in DDH, and to analyse the treatment strategy. Of the 21709 newborns (43418 hips) examined with US and Ortolani's manoeuvre for DDH diagnosis, 431 patients (356 F; 75 M; average age 42+/-33 days) had 574 unstable, dysplastic hips (1.32%). The hips identified according to Graf's classification were: 298 type D, 252 type IIIa, 4 type IIIb, 20 type IV. In 73.09% of the patients, no risk factors were identified; 18.56% had positive family history for DDH, 5.57% had breech presentation, 2.78% had both risk factors. Only 10.63% had a positive Ortolani's test. The diagnosis was made in 21.5% of cases by the 2nd week of life, in 52.9% between the 2nd-8th week, and in 25.5% after the 8th week. Unstable dislocated hips were treated, after reduction with or without sedation, by applying a cast; dysplastic hips were treated using a Gekeler splint. No open reductions or reconstruction surgery were needed. The labrum was always positioned on top of the femoral head, never inverted, and it was not an obstacle to closed reduction. Neither the Ortolani's sign, nor the risk factors are sure signs for the early diagnosis of DDH and its instability. Only US examination permits an early diagnosis of dysplasia and instability of the hip.

  3. Candidiasis: a fungal infection--current challenges and progress in prevention and treatment. (United States)

    Hani, Umme; Shivakumar, Hosakote G; Vaghela, Rudra; Osmani, Riyaz Ali M; Shrivastava, Atul


    Despite therapeutic advances candidiasis remains a common fungal infection most frequently caused by C. albicans and may occur as vulvovaginal candidiasis or thrush, a mucocutaneous candidiasis. Candidiasis frequently occurs in newborns, in immune-deficient people like AIDS patients, and in people being treated with broad spectrum antibiotics. It is mainly due to C. albicans while other species such as C. tropicalis, C. glabrata, C. parapsilosis and C. krusei are increasingly isolated. OTC antifungal dosage forms such as creams and gels can be used for effective treatment of local candidiasis. Whereas, for preventing spread of the disease to deeper vital organs, candidiasis antifungal chemotherapy is preferred. Use of probiotics and development of novel vaccines is an advanced approach for the prevention of candidiasis. Present review summarizes the diagnosis, current status and challenges in the treatment and prevention of candidiasis with prime focus on host defense against candidiasis, advancements in diagnosis, probiotics role and recent progress in the development of vaccines against candidiasis.

  4. Update on the diagnosis and treatment of pulmonary tuberculosis. (United States)

    Caminero Luna, J A


    Tuberculosis (TB) remains the most important human infectious disease. Currently, the TB diagnosis is still based on the clinical presentation, radiographic findings and microbiological results; all of which have sensitivity or specificity issues. For that reason, the immediate future involves rapid molecular microbiological techniques, in particular GeneXpert (which is more sensitive than bacilloscopy and is able to detect rifampicin resistance) and GenoType. The current six-month treatment for TB has remained unchanged for decades. Attempts to shorten this treatment have failed. In recent years, new drugs have been reported that could contribute to TB treatment in the near future, and are already being used in multi-drug-resistance TB. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Gorlin-Goltz Syndrome: Diagnosis and Treatment Options

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    João Mendes-Abreu


    Full Text Available The Gorlin-Goltz syndrome is a rare autosomal dominant hereditary condition, with complete penetrance and variable expressivity. Characterized by the appearance of multiple basaliomas, and often the development of keratocyst, it can also express itself by the presence of palmar/plantar depressions, calcification of brain sickle, and skeletal birth defects, although less frequently. This article presents two cases involving direct relatives, referred after the identification of several basaliomas and jaw cysts. After establishing the diagnosis, given the identification of three major criteria, the treatment consisted in the excision of the lesions followed, in one case, with vismodegib treatment resulting in complete remission. Gorlin-Goltz syndrome is therefore a multidisciplinary challenge, whose variable morbidity and high risk of recurrence make treatment and surveillance critical. However, new molecular targeted therapies have brought a new hope in treating these patients.


    Directory of Open Access Journals (Sweden)

    Sandrina Carvalho


    Conclusion: The treatment of tinea capitis is simple and effective. Timely identification and treatment are essential to prevent the formation of a cicatricial alopecia, often disturbing for the patient.

  7. Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. (United States)

    Kreher, Jeffrey B


    Overtraining syndrome is a condition of maladapted physiology in the setting of excessive exercise without adequate rest. The exact etiology and pathogenesis are unknown and being investigated. Symptoms are multisystem in nature and often representative of underlying hormonal, immunologic, neurologic, and psychologic disturbances. Unfortunately, systematic review of the literature does not clearly direct diagnosis, management, or prevention. However, given the severity of symptoms and impairment to quality of life, prevention of overtraining syndrome should be considered by all who interact with endurance athletes. This article will provide suggestions for management of at-risk athletes despite absence of validated diagnostic tests and preventative measures.

  8. Advances in diagnosis and treatment of metastatic cervical cancer (United States)


    Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases. PMID:27171673

  9. The effects of residential dual diagnosis treatment on alcohol abuse (United States)

    Schoenthaler, Stephen J; Blum, Kenneth; Fried, Lyle; Oscar-Berman, Marlene; Giordano, John; Modestino, Edward J.; Badgaiyan, Rajendra


    This multi-center study of dual diagnosis (DD) programs involved 804 residential patients with co-occurring alcohol and mental health disorders. The Addiction Severity Index was administered at admission and at one, six, and 12 months after discharge. Repeated measures analysis showed the intoxication rate per month stabilized between months six and 12 with 68% still in remission and an 88% mean reduction from baseline (F = 519, p treatment of both disorders and explained their effectiveness. Co-occurring DSM IV mood disorders such as anxiety and depression as well as drug abuse involving opioids or cocaine fell between 66 and 95% at months one, six, and twelve. PMID:28868159

  10. Excessive gingival display--etiology, diagnosis, and treatment modalities. (United States)

    Silberberg, Nir; Goldstein, Moshe; Smidt, Ami


    Extensive exposure of the gingiva during a smile, called excessive gingival display, may be a point of concern for both patients and clinicians. Patients often present to the dental clinic seeking a solution to their "gummy" appearance. A clinician must fully understand the various factors involved in this situation, to provide patients with an appropriate answer. Thorough examination followed by the right diagnosis is imperative for achieving an esthetic and predictable result in the treatment of such situations. The aim of this article is to discuss the various aspects of excessive gingival display and its etiology and to present the current solutions that exist in the literature.


    Vásquez T , Oscar; Alvarez Ch , Rubén; Gonzales S , Napoleón; Neme D , Gonzalo A.; Romero C , Raúl; Valencia R , Silvia; Gomez A, Valente; Martinez B, Ignacio


    The study was made to determine the clinical profile and laboratory of 10 paediatric patients whose diagnosis of cyclosporiosis was established by identifying the parasite in fecal matter, through a smear with modified Zehl-Nielsen and incubation in dichromate of potassium. We obtained clinical data form these patients correlating them with absorption tests (digestive activity, sugar reducers and fats in feces.)After treatment with trimethroprim-sulfamethoxazole and nitazoxanide patients were controlled by laboratory exams to determine the existence of the parasite and its viability.

  12. Osteochondritis Dissecans of the Capitellum: Diagnosis and Treatment. (United States)

    Glait, Sergio A; Rokito, Andrew S; Jazrawi, Laith M


    Osteochondritis dissecans (OCD) of the capitellum is an articular cartilage lesion commonly affecting young adolescents. The exact mechanism for the development of these lesions is still uncertain; however, both traumatic and vascular etiologies have been described. Careful physical examination in conjunction with appropriate diagnostic studies helps the surgeon to classify these lesions as stable or unstable and leads to proper management. There is a diverse array of treatments available for OCD lesions of the capitellum, including fragment excision or fixation, bone marrow stimulation, and osteochondral autograft transplantation. This review helps the orthopaedic surgeon understand the diagnosis and management options available for OCD lesions of the capitellum.

  13. Delay in Presentation, Diagnosis and Treatment for Colorectal Cancer Patients in Jordan. (United States)

    Abu-Helalah, Munir Ahmad; Alshraideh, Hussam Ahmad; Da'na, Moh'd; Al-Hanaqtah, Mo'tasem; Abuseif, Anas; Arqoob, Kamal; Ajaj, Abdelrahman


    Colorectal cancer (CRC) ranked first among cancers reported in males and second among cancers reported in females in Jordan in 2010. There has been no specific CRC-control programme in Jordan. Additionally, there has been no published study from Jordan or its neighbours on patient delays in presentation, diagnosis or treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for CRC and to provide baseline data for future health promotion programmes for CRC in Jordan. This project was a cross-sectional study on CRC patients at Al Bashir Hospital, Ministry of Health, and at the Military Oncology Centre of the Jordanian Royal Medical Services. The total number of participants was 189. The proportion of patients with presentation delay, diagnosis delay or treatment delay was 33.9, 68.1 and 32.6%, respectively. The main reasons reported for delay in presentation were lack of knowledge that symptoms were suggestive of cancer (58.5%), misdiagnosis by physicians or pharmacists (38.4%) or the patient did not want to visit a doctor (3.1%). Predictors of delay and mean time for presentation, diagnosis and treatment were identified. Our results revealed that CRC patients in Jordan experience delays in presentation, Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnosis, and, to a lesser degree, in treatment. This could justify the advanced stages at diagnosis and poor outcomes for CRC patients. Our findings provide baseline information for future CRC-control programmes in Jordan. We recommend that CRC prevention programmes in Jordan focus on early detection of CRC and target both patients and physicians.

  14. Binocular diplopia in a tertiary hospital: Aetiology, diagnosis and treatment. (United States)

    Merino, P; Fuentes, D; Gómez de Liaño, P; Ordóñez, M A


    To study the causes, diagnosis and treatment in a case series of binocular diplopia. A retrospective chart review was performed on patients seen in the Diplopia Unit of a tertiary centre during a one-year period. Diplopia was classified as: acute≤1 month since onset; subacute (1-6 months); and chronic (>6 months). Resolution of diplopia was classified as: spontaneous if it disappeared without treatment, partial if the course was intermittent, and non-spontaneous if treatment was required. It was considered a good outcome when diplopia disappeared completely (with or without treatment), or when diplopia was intermittent without significantly affecting the quality of life. A total of 60 cases were included. The mean age was 58.65 years (60% female). An acute or subacute presentation was observed in 60% of the patients. The mean onset of diplopia was 82.97 weeks. The most frequent aetiology was ischaemic (45%). The most frequent diagnosis was sixth nerve palsy (38.3%), followed by decompensated strabismus (30%). Neuroimaging showed structural lesions in 17.7% of the patients. There was a spontaneous resolution in 28.3% of the cases, and there was a good outcome with disappearance of the diplopia in 53.3% at the end of the study. The most frequent causes of binocular diplopia were cranial nerve palsies, especially the sixth cranial nerve, followed by decompensated strabismus. Structural lesions in imaging tests were more than expected. Only one third of patients had a spontaneous resolution, and half of them did not have a good outcome despite of treatment. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Pathophysiology, Diagnosis and Treatment of Somatosensory Tinnitus: A Scoping Review

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    Haúla F. Haider


    Full Text Available Somatosensory tinnitus is a generally agreed subtype of tinnitus that is associated with activation of the somatosensory, somatomotor, and visual-motor systems. A key characteristic of somatosensory tinnitus is that is modulated by physical contact or movement. Although it seems common, its pathophysiology, assessment and treatment are not well defined. We present a scoping review on the pathophysiology, diagnosis, and treatment of somatosensory tinnitus, and identify priority directions for further research.Methods: Literature searches were conducted in Google Scholar, PubMed, and EMBASE databases. Additional broad hand searches were conducted with the additional terms etiology, diagnose, treatment.Results: Most evidence on the pathophysiology of somatosensory tinnitus suggests that somatic modulations are the result of altered or cross-modal synaptic activity within the dorsal cochlear nucleus or between the auditory nervous system and other sensory subsystems of central nervous system (e.g., visual or tactile. Presentations of somatosensory tinnitus are varied and evidence for the various approaches to treatment promising but limited.Discussion and Conclusions: Despite the apparent prevalence of somatosensory tinnitus its underlying neural processes are still not well understood. Necessary involvement of multidisciplinary teams in its diagnosis and treatment has led to a large heterogeneity of approaches whereby tinnitus improvement is often only a secondary effect. Hence there are no evidence-based clinical guidelines, and patient care is empirical rather than research-evidence-based. Somatic testing should receive further attention considering the breath of evidence on the ability of patients to modulate their tinnitus through manouvers. Specific questions for further research and review are indicated.

  16. Paradoxical embolism: role of imaging in diagnosis and treatment planning. (United States)

    Saremi, Farhood; Emmanuel, Neelmini; Wu, Phil F; Wu, Philip F; Ihde, Lauren; Shavelle, David; Go, John L; Sánchez-Quintana, Damián


    Paradoxical embolism (PDE) is an uncommon cause of acute arterial occlusion that may have catastrophic sequelae. The possibility of its presence should be considered in all patients with an arterial embolus in the absence of a cardiac or proximal arterial source. Despite advancements in radiologic imaging technology, the use of various complementary modalities is usually necessary to exclude other possibilities from the differential diagnosis and achieve an accurate imaging-based diagnosis of PDE. In current practice, the imaging workup of a patient with symptoms of PDE usually starts with computed tomography (CT) and magnetic resonance (MR) imaging to identify the cause of the symptoms and any thromboembolic complications in target organs (eg, stroke, peripheral arterial occlusion, or visceral organ ischemia). Additional imaging studies with modalities such as peripheral venous Doppler ultrasonography (US), transcranial Doppler US, echocardiography, and CT or MR imaging are required to detect peripheral and central sources of embolism, identify cardiac and/or extracardiac shunts, and determine whether arterial disease is present. To guide radiologists in selecting the optimal modalities for use in various diagnostic settings, the article provides detailed information about the imaging of PDE, with numerous radiologic and pathologic images illustrating the wide variety of features that may accompany and contribute to the pathologic process. The roles of CT and MR imaging in the diagnosis and exclusion of PDE are described, and the use of imaging for planning surgical treatment and interventional procedures is discussed.

  17. [Clinical Pathological Diagnosis, and Treatment for Pleural Mesothelioma]. (United States)

    Kishimoto, Takumi; Fujimoto, Nobukazu; Nishi, Hideyuki


    For the differential diagnosis between fibrous pleuritis and other malignancies such as lung cancer, multiple immunostaining is essential to diagnose pleural mesothelioma. For cytological diagnosis of pleural effusions, differentiation between mesothelioma cells and reactive mesothelial cells is very difficult. Therefore, histological diagnoses of tumor tissues obtained via biopsy are essential. To diagnose epthelioid mesothelioma, more than 2 positive and negative markers must be consistent with those known for mesothelioma. To diagnose sarcomatoid mesothelioma, keratin is usually positive, differentiating the diagnosis from that for real sarcoma. For surgical treatment for pleural mesothelioma, extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are usually performed. The proportion of P/D increases because of the low death rates with surgery and similar survivals. However, a trimodal approach, such as EPP with chemotherapy and radiotherapy, is best for longer survival and expected to be curative. For chemotherapy, only cisplatin (CDDP) combined with pemetrexed (PEM) is effective, and no other agents have been identified for this disease. Nowadays, clinical immunotherapy trials start with phase II study.

  18. Combinatorial Therapies for Neurofibroma and MPNST Treatment and Prevention (United States)


    AWARD NUMBER: W81XWH-15-1-0193 TITLE: Combinatorial Therapies for Neurofibroma and MPNST Treatment and Prevention PRINCIPAL INVESTIGATOR...2016 - 31 Jul 2017 4. TITLE AND SUBTITLE Combinatorial Therapies for Neurofibroma and MPNST Treatment and Prevention 5a. CONTRACT NUMBER 5b. GRANT...with these drugs will prevent neurofibroma and MPNST pathogenesis. To test these hypotheses, we will: 1) determine whether tamoxifen, trifluoperazine

  19. Early diagnosis of the urofacial syndrome is essential to prevent irreversible renal failure

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    Francisco A. Nicanor


    Full Text Available INTRODUCTION: The urofacial or Ochoa syndrome is a rare disease characterized by the presence of functional obstructive uropathy associated with peculiar facial features when patients attempt to smile or laugh. Unfortunately, many of these patients remain without proper diagnosis or adequate treatment due to lack of recognition of the disease. This can ultimately result in upper tract deterioration and eventual renal failure. We present our experience with this rare syndrome. MATERIALS AND METHODS: We identified 3 patients who presented initially with acute renal failure, urinary tract infection (UTI and severe dysfunctional elimination. All patients were thoroughly evaluated, including screening for spinal cord anomalies, and were subsequently diagnosed with urofacial syndrome. RESULTS: At the outset, the two older patients (aged 4 and 9 years presented with the typical facial features when attempting to smile or laugh. One patient in the newborn period presented with urinary and fecal retention and septicemia and, to our knowledge, represents the youngest case of urofacial syndrome reported so far. All patients were evaluated with ultrasonography, renal scan, voiding cystourethrogram (VCUG and urodynamics. Findings included hydronephrosis and a thick-walled, trabeculated bladder with poor compliance and detrusor hypereflexia respectively in each patient. All were subsequently treated with clean intermittent catheterization (CIC, antibiotic prophylaxis and anticholinergic therapy. One patient required appendicovesicostomy for CIC due to discomfort secondary to a sensate urethra. CONCLUSIONS: Our series demonstrates that early recognition of this rare syndrome is necessary to adequately treat and prevent upper tract deterioration in these unique individuals. Although the urofacial is difficult to diagnose in infants, cognizance must be maintained in order to prevent severe subsequent sequalae.

  20. Pregnancy-associated venous thromboembolism: Part I- Deep vein thrombus diagnosis and treatment

    International Nuclear Information System (INIS)

    Al-Gahtani, Farjah H.


    Venous thromboembolic (VTE) complications are leading causes of mortality in the developed world. Over the past 20 years, there has been an increase of deep venous thrombosis (DVT) in the pregnant women, and this increase may be explained by the risk factors including older age, cesarean section, history of VTE and presence of thrombophilia. To reduce the incidence of VTE in pregnancy and improve the outcomes, a wider understanding of the risk factors and a better identification of women at a risk of the thrombosis, with objective diagnosis and provide the optimal effective and safe treatment. Deep venous thrombosis and pulmonary embolism, considered manifestations of the same disease, are often preventable and usually treatable. Nevertheless, VTE remains a substantial problem despite the dramatic decline in pregnancy-related mortality in industrialized countries over the past century. While diagnosis and management of VTE in pregnancy are challenging, and many diagnosis tests are less accurate in pregnant than non-pregnant patients and the available options are suboptimal. This is a review in 2 parts, in part I, we address the following questions. In pregnant women, who developed DVT; how to diagnose and the treatment once the diagnosis is confirmed. For each of these problems, the relevant background is briefly summarized, approaches recommended and the suggested practical and relatively safe diagnostic management approaches. Part II, we address pregnant women with pulmonary embolism, how to diagnose and treat. (author)

  1. Chronic Gastritis: a Continuum of Diagnosis and Treatment

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    Yu.M. Stepanov


    Full Text Available The article describes the main stages of the development of views on the diagnosis of chronic gastritis with highlighting the issue of diagnosis as an integral part of the set of measures concerning the timely detection of preneoplastic changes in the gastric mucosa. The main views on the development of carcinogenesis are presented based on current knowledge about the factors influencing the course of this process. Among known measures to prevent the development of precancerous changes, today the most important ones are the reliable stratification of risk groups in terms of their development and the strategy for identifying and eliminating Helicobacter pylori as a recognized factor of carcinogenesis. The development of bacterial resistance to basic medications recommended in the schemes of eradication therapy causes a further search of ways to enhance their effectiveness. As shown in a number of studies, the results of which are presented in the article, the most reliable is the inclusion of bismuth subcitrate (De-Nol in the schemes of eradication.

  2. Considering treatment of male genital schistosomiasis as a tool for future HIV prevention

    DEFF Research Database (Denmark)

    Stecher, Chalotte Willemann; Kallestrup, Per; Kjetland, Eyrun Floerecke


    and acquisition, and treatment could be a neglected chance of HIV prevention. This review summarizes current knowledge on epidemiology, clinical manifestations, diagnosis and treatment of MGS as a hypothesized risk factor for HIV transmission. Future research areas of global interest are suggested. METHODS: Pub...... association between MGS and HIV are urgently needed. Furthermore, field diagnostic tools should be developed and future mass treatment programs should include adults to reduce morbidity and prevent HIV acquisition. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42015016252.......OBJECTIVES: Male genital schistosomiasis (MGS) is a neglected manifestation of Schistosoma haematobium infection with ignored implications on reproductive health and a differential diagnosis to sexually transmitted infections in endemic regions. MGS may have associations with HIV transmission...

  3. Guideline for the prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons: 2013 update

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    The Southern African HIV Clinicians Society


    Full Text Available Six years after the first Society guidelines were published, cryptococcal meningitis (CM remains an important cause of morbidity and mortality among HIV-infected adults in South Africa. Several important developments have spurred the  publication of updated guidelines to manage this common fungal opportunistic infection. Recommendations described here include: (1 screening and pre-emptive treatment; (2 laboratory diagnosis and monitoring; (3 management of a first episode of CM; (4 amphotericin B deoxycholate toxicity prevention, monitoring and management; (5 timing of antiretroviral therapy among patients with CM; (6 management of raised intracranial pressure; (7 management of relapse episodes of CM.

  4. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. (United States)

    Franz, Eric W; Bentley, J Nicole; Yee, Patricia P S; Chang, Kate W C; Kendall-Thomas, Jennifer; Park, Paul; Yang, Lynda J S


    OBJECT Patient outcome measures are becoming increasingly important in the evaluation of health care quality and physician performance. Of the many novel measures currently being explored, patient satisfaction and other subjective measures of patient experience are among the most heavily weighted. However, these subjective measures are strongly influenced by a number of factors, including patient demographics, level of understanding of the disorder and its treatment, and patient expectations. In the present study, patients referred to a neurosurgery clinic for degenerative spinal disorders were surveyed to determine their understanding of lumbar spondylosis diagnosis and treatment. METHODS A multiple-choice, 6-question survey was distributed to all patients referred to a general neurosurgical spine clinic at a tertiary care center over a period of 11 months as a quality improvement initiative to assist the provider with individualized patient counseling. The survey consisted of questions designed to assess patient understanding of the role of radiological imaging in the diagnosis and treatment of low-back and leg pain, and patient perception of the indications for surgical compared with conservative management. Demographic data were also collected. RESULTS A total of 121 surveys were included in the analysis. More than 50% of the patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms; more than 40% of patients indicated the same for plain radiographs. Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain. Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery. There were no significant differences in survey responses among patients with a previous history of spine surgery compared with those without previous spine surgery. CONCLUSIONS These

  5. Infection after total knee replacement: diagnosis and treatment

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    Lucio Honorio de Carvalho Junior


    Full Text Available Infection after total knee replacement (IATJ is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases. Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

  6. Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

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    Nikolaos Mouchtouris


    Full Text Available Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics.


    Fernandes, Tiago Lazzaretti; Pedrinelli, André; Hernandez, Arnaldo José


    Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides such injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by: ultrasound, which is dynamic and cheap, but examiner dependent; and tomography or magnetic resonance, which gives better anatomical definition, but is static. Initial phase of the treatment can be summarized as the “PRICE” protocol. NSAIDs, ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement. PMID:27047816

  8. Diagnosis and treatment of chronic cerebrovascular disease, use of pentoxifylline

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    V. A. Parfenov


    Full Text Available Chronic cerebrovascular disease (CCVD is one of the most common  iagnoses in Russian neurology, by which is meant vascular cognitive impairment (VCI in modern foreign literature. There are data available in the literature on the diagnosis and treatment of CCVD (VCI. Theresults of the author’s studies show that CCVD often masks other diseases (anxiety and depressive disorders, primary headache, peripheral vestibulopathy, and Alzheimer's disease that are unfortunately poorly diagnosed in our country, so patients do not receive effective treatment. To modify risk factors for stroke (smoking and alcohol cessation, sufficient exercise, to normalize blood pressure (the use of antihypertensivemedications, to reduce blood cholesterol levels (statins, to perform antithrombotic therapy (antiplatelet agents and anticoagulants, and to use cognitive enhancers are of key importance when treating patients with CCVD (VCI. There are data on the use of pentoxifylline in patients with CCVD, vascular dementia.

  9. Diagnosis, treatment, and response assessment in solitary plasmacytoma

    DEFF Research Database (Denmark)

    Caers, J; Paiva, B; Zamagni, E


    Solitary plasmacytoma is an infrequent form of plasma cell dyscrasia that presents as a single mass of monoclonal plasma cells, located either extramedullary or intraosseous. In some patients, a bone marrow aspiration can detect a low monoclonal plasma cell infiltration which indicates a high ris......, but studies exploring the potential benefit of systemic therapies for high-risk patients are urgently needed. In this review, a panel of expert European hematologists updates the recommendations on the diagnosis and management of patients with solitary plasmacytoma....... of early progression to an overt myeloma disease. Before treatment initiation, whole body positron emission tomography-computed tomography or magnetic resonance imaging should be performed to exclude the presence of additional malignant lesions. For decades, treatment has been based on high-dose radiation...

  10. Osteo-articular infections in newborns: diagnosis and treatment. (United States)

    Dessì, A; Crisafulli, M; Accossu, S; Setzu, V; Fanos, V


    Osteoarticular infections, although uncommon, represent a severe condition in neonates. Infections in newborns are largely of an acute nature, transmitted by hematogenous means. The most frequently observed etiological agents are: Staphylococcus aureus, Gram negative and group B Streptococcus spp. In the majority of cases the metaphyses of the long bone are the most commonly implicated sites, although infection may spread to the contiguous epiphysis and joint in neonates. Diagnosis of acute septic arthritis and osteomyelitis may be hindered, especially in neonates, due to the manifestation of less clear-cut characteristic symptoms and signs compared to in children. When osteomyelitis is suspected, imaging techniques used in association with blood and tissue cultures are the most reliable diagnostic tests. Antimicrobial treatment should be administered for 3-4 weeks, initially intravenously, later switching to oral medication. Surgery is indicated to drain acute abscesses or when no improvement is achieved following antibiotic treatment.

  11. [Guideline for the diagnosis and treatment of acute bacterial meningitis]. (United States)

    DŽupová, Olga; Helcl, Miroslav; Kračmarová, Renata; Krbková, Lenka; Pařízková, Radana; RoŽnovský, Luděk


    Acute bacterial meningitis is a severe infectious disease of the central nervous system. Its incidence decreases but lethality and sequelae remain high. The early initiation of appropriate treatment is a factor strongly determining the patient´s prognosis. The authors submit the Czech national guideline for diagnosis and treatment of community-acquired acute bacterial meningitis which has to provide clear and simple recommendations for clinicans involved in the care of meningitis in adults and children. The national guideline was based on the European guideline published in 2016 and adapted for the situation in the Czech Republic. It was acknowledged (approved? ratified?) by the Society for Epidemiology and Microbiology and the Society for Medical Microbiology of the Czech Medical Association.

  12. Psychosomatic aspects in the diagnosis and treatment of erectile dysfunction. (United States)

    Beutel, M


    After a critical review of prevalence data, psychosocial determinants and psychosomatic aspects in the diagnosis and treatment of erectile dysfunction are discussed (with reference to age-related changes). Widely used laboratory assessments are responsive to psychological factors (e.g. anxiety). Inclusion of the partner in the diagnostic process may change the clinical picture and the treatment recommendations considerably. As illustrated by penile prosthetis treatment and self-injection of vasoactive substances, acceptance and success of widely used surgical and medical treatments depend largely upon the patient's expectations, and the adaptation of the couple to the procedure. Even in cases with a clear organic pathology, fluctuations in erectile functioning may be attributable to psychological influences. As recent psychotherapeutic and psychoeducational approaches underscore, erectile failure is best conceived as a final common pathway of somatic, lifestyle, psychological and partnership determinants. These should be taken into account in comprehensive diagnostic and treatment formulations if the goal of therapy is not only to produce rigid erections, but to increase sexual satisfaction.

  13. Diagnosis and treatment of chronic constipation – a European perspective (United States)

    Tack, J; Müller-Lissner, S; Stanghellini, V; Boeckxstaens, G; Kamm, M A; Simren, M; Galmiche, J-P; Fried, M


    Background Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe. Purpose We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted. PMID:21605282

  14. Technology needs for tomorrow's treatment and diagnosis of macular diseases (United States)

    Soubrane, Gisèle


    Retinal imaging is the basis of macular disease's diagnosis. Currently available technologies in clinical practice are fluorescein and indocyanin green (ICG) angiographies, in addition to optical coherence tomography (OCT), which is an in vivo "histology-like" cross-sectional images of the retina. Recent developments in the field of OCT imaging include Spectral-Domain OCT. However OCT remains a static view of the macula with no direct link with dynamic observation obtained by angiographies. Adaptative optics is an encouraging perspective for fundus analysis in the future, and could be linked to OCT or angiographies. Treatments of macular disease have exploded these past few years. Pharmacologic inhibition of angiogenesis represents a novel approach in the treatment of choroidal neovascularization in eyes with age-related macular degeneration. The major action explored is the direct inhibition of the protein VEGF with antibody-like products. New anti-VEGF drugs are in development aiming at the VEGF receptors or synthesis of VEGF. But various components of the neovascular cascade, including growth factor expression, extracellular matrix modulation, integrin inhibition represent potential targets for modulation with drugs. Intra-vitreal injections are nowadays the main route of administration for these new treatments but they are potentially responsible of side effects such as endophtalmitis. Development of other routes of treatment would require new formulation of used drugs. The improvement of retinal imaging leads to a better understanding of macular disease mechanisms and will help to develop new routes and targets of treatment.

  15. Malignant pleural mesothelioma: incidence, etiology, diagnosis, treatment, and occupational health. (United States)

    Neumann, Volker; Löseke, Stefan; Nowak, Dennis; Herth, Felix J F; Tannapfel, Andrea


    The incidence of malignant mesothelioma in Germany is about 20 cases per million persons per year. Its association with asbestos exposure, usually occupational, has been unequivocally demonstrated. Even though the industrial use of asbestos was forbidden many years ago, new cases of mesothelioma continue to appear because of the long latency of the disease (median, 50 years). Its diagnosis and treatment still present a major challenge for ambulatory and in-hospital care and will do so for years to come. This article is based on a selective review of the literature, along with data from the German Mesothelioma Register. 1397 people died of mesothelioma in Germany in 2010. A plateau in the incidence of the disease is predicted between 2015 and 2030. Most mesotheliomas arise from the pleura. The histological subtype and the Karnofsky score are the main prognostic factors. Only limited data are now available to guide treatment with a combination of the available methods (chemotherapy, surgery, radiotherapy). The prognosis is still poor, with a median survival time of only 12 months. Symptom control and the preservation of the patient's quality of life are the main aspects of care for patients with mesothelioma. The incidence of mesothelioma is not expected to drop in the next few years. The available treatments are chemotherapy, surgery, and radiotherapy. Specialized treatment centers now increasingly provide multimodal therapy for treatment of mesothelioma.

  16. Еctopic ACTH syndrome: clinical picture, diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    N S Kuznetsov


    Full Text Available Diagnosis and treatment of ectopic ACTH-syndrome currently is one of the most challenging problems among other forms of endogenous hypercorticism. This syndrome is associated with presence of extrapituitary tumors characterized with different histogenesis and localization, which produce adrenocorticotropic hormone (ACTH, or – rarely – corticotrophin-releasing hormone. In most cases the ectopic synthesis of ACTH is performed in bronchial carcinoid tumors (36–46%, oat cell cancer (18–20%, medullary thyroid cancer (3–7%, pheochromocytoma (9–23%, other sites are infrequent (pancreas, thymus, parotid gland, ovaries, uterus, prostate, colon, stomach, esophagus, etc.. Much of these tumors are aggressive and are characterized with propensity to metastasize and relapse. Currently there are few contradictory data on the comparative evaluation of the effectiveness of methods of topical diagnosis of the source of ectopic ACTH-secretion, and therefore there is an urgent need to develop an optimal and most efficient algorithm for diagnostic procedures to determine the extent of the tumor in patients with ectopic ACTH-syndrome. Indications for surgery, timing and extent of surgical intervention, the effectiveness of the operation, the causes and frequency of relapses are still discussed.The present difficulties of diagnosis, as well as the lack of a unified approach to the treatment of this disease in the complex, often lead to the progression and development of a large number of serious complications functions of up to disability, which in turn does not lead to significant improvement of quality of life. Thus further research is necessary to study of this disease

  17. [Diagnosis and treatment of familial hypercholesterolemia in Spain: consensus document]. (United States)

    Mata, Pedro; Alonso, Rodrigo; Ruiz, Antonio; Gonzalez-Juanatey, Jose R; Badimón, Lina; Díaz-Díaz, Jose L; Muñoz, María Teresa; Muñiz, Ovidio; Galve, Enrique; Irigoyen, Luis; Fuentes-Jiménez, Francisco; Dalmau, Jaime; Pérez-Jiménez, Francisco


    Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are < 130 mg/dL for children and young adults, <100mg/dL for adults, and < 70 mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥ 50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  18. [Diagnosis and treatment of familial hypercholesterolemia in Spain: Consensus document]. (United States)

    Mata, Pedro; Alonso, Rodrigo; Ruiz, Antonio; Gonzalez-Juanatey, Jose R; Badimón, Lina; Díaz-Díaz, Jose L; Muñoz, María Teresa; Muñiz, Ovidio; Galve, Enrique; Irigoyen, Luis; Fuentes-Jiménez, Francisco; Dalmau, Jaime; Pérez-Jiménez, Francisco


    Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are <130mg/dL for children and young adults, <100mg/dL for adults, and <70mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  19. What's new in differential diagnosis and treatment of hoarseness? (United States)

    Ulis, Jeffrey M; Yanagisawa, Eiji


    To review the literature published over the past year (2008) regarding the diagnosis and management of patients with hoarseness. There has been a lack of large, controlled, prospective studies regarding diagnosis and management for dysphonic patients. High-speed digital imaging is gradually becoming a useful adjunct to stroboscopy in patients with hoarseness and aperiodicity. Presence of blood vessels in vocal fold lesions may help distinguish otherwise similar entities. Early speech therapy has been useful for patients with suspected reflux who did not respond to an initial antacid trial. Voice break analysis can help differentiate between hyperfunctional speech disorders. Fibroblast growth factor may be an effective new treatment for presbylaryngis. Bilateral botox injection has been effective and well tolerated for refractory vocal granuloma and abductor spasmodic dysphonia. Hoarseness is a frequently encountered symptom that may result from many local and systemic disease processes. Differentiating subtle vocal fold pathologies and treatment of often ill-defined disorders remains a challenge. New approaches are described in the recent literature, but further studies are required for validation.

  20. Diagnosis and treatment of hypertriglyceridemic pancreatitis in pregnancy

    Directory of Open Access Journals (Sweden)

    GAO Nana


    Full Text Available Objective To investigate the clinical diagnosis and treatment of hypertriglyceridemic pancreatitis in pregnancy (HPP. Methods The clinical data of 29 patients with HPP who were admitted to Yulin Hospital of Traditional Chinese Medicine from June 2005 to June 2015 were retrospectively analyzed. Results Of all the 29 patients, 5 (17.2% were in the first trimester and 24 (82.8% were in the third trimester; among them, 8 (27.6% had mild pancreatitis, 14 (48.3% had moderate pancreatitis, and 7 (24.1% had severe pancreatitis. The patients had a mean serum triglyceride level of 15.5 mmol/L. No pregnant women died; the mortality rate of the fetuses reached 17.2% (5/29, and all of the five cases were intrauterine fetal death. Conclusion Although the prevalence of HPP is low, its incidence rate is increasing gradually, and HPP is commonly seen in the third trimester. HPP is always associated with a high fetal mortality rate, and therefore, timely diagnosis and treatment should be provided to improve the prognosis of mother and fetus.

  1. Diagnosis and treatment of radiation-induced burns

    International Nuclear Information System (INIS)

    Portas, Mercedes; Pomerane, Armando; Genovese, Jorge; Perez, Maria R.; Gisone, Pablo


    The utilization of radioactive sources in medicine, industry and research is associated with a probability of accidental overexposures to ionizing radiation, among which localized irradiation are the most frequent events. Moreover, between 5 and 8 % of the patients undergoing therapeutical irradiations could exhibit a higher individual radiosensitivity which could account for severe skin reactions. Localized overexposures may damage not only epidermis and dermis but also deeper connective tissue, vessels, muscles and even bones. Within the framework of a cooperation agreement between the Buenos Aires Burn Hospital and the National Board of Nuclear Regulation, a Radio pathology Committee has been established in 1997 with the purpose of carrying out a collaborative project concerning diagnosis and treatment of radiological burns. The present document particularly considers radiological burns form the point of view of their physiopathology, physical and biological dosimetry, diagnosis prognosis and treatment. It also includes basic concepts of radiation biology and radio pathology. It could be an useful tool for training medical practitioners and also a practical guidance for organizing medical response in accidental overexposures. (author)

  2. Membranous nephropathy: A review on the pathogenesis, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    Wei Ling Lai


    Full Text Available In adults, membranous nephropathy (MN is a major cause of nephrotic syndrome. However, the etiology of approximately 75% of MN cases is idiopathic. Secondary causes of MN are autoimmune diseases, infection, drugs, and malignancy. The pathogenesis of MN involves formation of immune complex in subepithelial sites, but the definite mechanism is still unknown. There are three hypotheses about the formation of immune complex, including preformed immune complex, in situ immune-complex formation, and autoantibody against podocyte membrane antigen. The formation of immune complex initiates complement activation, which subsequently leads to glomerular damage. Recently, the antiphospholipase A2 receptor antibody was found to be associated with idiopathic MN. This finding may be useful in the diagnosis and prognosis of MN. The current treatment includes best supportive care, which consists of the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, lipid-lowering agents, and optimal control of blood pressure. Immunosuppressive agents should be used for patients who suffer from refractory proteinuria or complications associated with nephrotic syndrome. Existing evidence supports the use of a combination of steroid and alkylating agents. This article reviews the epidemiology, pathogenesis, diagnosis, and the treatment of MN.

  3. Experience of diagnosis and treatment of Gitelman syndrome

    Directory of Open Access Journals (Sweden)

    Shuo TIAN


    Full Text Available Objective To analyze the clinical characteristics and provide the experiences in diagnosis and treatment of 3 cases of Gitelman syndrome (GitS. Methods Three patients diagnosed as GitS were selected as the objects in Tangshan gongren Hospital from Aug. 2010 to Jan. 2017. Their clinical data were retrospectively analyzed and combined with the related literatures, and the clinical characteristics and treatment experiences of the disease were discussed. Results Of the 3 patients, 2 were teenager onset and another one was adult onset. The blood pressure of the 3 patients was normal, and the clinical features were as paroxysmal weakness, tetany, polyuria and nocturia increased. Laboratory tests revealed low potassium, low sodium, low chlorine, hypomagnesemia, occasionally hypocalcemia, high urinary potassium, metabolic alkalosis, urine Ca/Cr ≤0.2, plasma rennin activity increased significantly and plasma aldosterone was normal. Being eliminated symptoms and phenomena were the potassium intake inadequate, loss of potassium in digestive tract, taking potassium excretion drugs, primary aldosteronism and Cushing syndrome. etc. Patients got symptoms relief and serum potassium level rose to near normal level after receiving the combined potassium and magnesium supplement. Conclusions The clinical characteristics of GitS manifest as fatigue, tetany, normal blood pressure, hypokalemia, hypomagnesemia, metabolic alkalosis, plasma rennin activity increases significantly and plasma aldosterone rises or normal. Treatment with combined potassium and magnesium supplement may lead to a good prognosis, but hypomagnesemia is harder to correct. Kidney damage can be avoided by early diagnosis and treatment. DOI: 10.11855/j.issn.0577-7402.2017.12.13

  4. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis

    Directory of Open Access Journals (Sweden)

    Rodrigo Abensur Athanazio

    Full Text Available ABSTRACT Cystic fibrosis (CF is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions.

  5. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis (United States)

    Athanazio, Rodrigo Abensur; da Silva, Luiz Vicente Ribeiro Ferreira; Vergara, Alberto Andrade; Ribeiro, Antônio Fernando; Riedi, Carlos Antônio; Procianoy, Elenara da Fonseca Andrade; Adde, Fabíola Villac; Reis, Francisco José Caldeira; Ribeiro, José Dirceu; Torres, Lídia Alice; de Fuccio, Marcelo Bicalho; Epifanio, Matias; Firmida, Mônica de Cássia; Damaceno, Neiva; Ludwig-Neto, Norberto; Maróstica, Paulo José Cauduro; Rached, Samia Zahi; Melo, Suzana Fonseca de Oliveira


    ABSTRACT Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions. PMID:28746534

  6. Benign paroxysmal positional vertigo in outpatient practice: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    N. V. Bestuzheva


    Full Text Available Dizziness is one of the common reasons for visits to physicians of various specialties; the data of foreign investigations show that benign paroxysmal positional vertigo (BPPV is most frequently encountered.Objective: to study the causes of dizziness, to analyze the frequency of BPPV and the efficiency of its treatment in outpatient practice.Patients and methods. The investigation enrolled 80 patients, including 55 (68.7% women and 25 (31.3% men, aged 18 to 75 years (mean age 53.8±12.8 years, who complained of dizziness and sought for medical advice in the Therapeutic-and-Diagnostic Unit, A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University.Results. The most common causes of dizziness in outpatient practice were BPPV (46.2% and postural phobic vertigo (35%. The diagnosis of VPPV, if special positional testing (Dix-Hallpike and McClure-Pagnini tests was carried out, was shown to create no significant difficulties. The diagnosis was not established in the majority (97.5% of the patients; effective treatment was performed in one of the patients. Combined treatment, by performing the positional tests and using betaserc for 2 months, led to complete resolution of positional vertigo in most (97.3% patients.Discussion. The findings indicate the efficiency of examining patients with complaints of dizziness, by using the special otoneurological tests to detect BPPV. The purposeful questioning of patients with BPPV can suspect this disease in the majority of cases. Our investigation shows the high efficiency of rehabilitation maneuvers for BPPV, which agrees well with the data of other authors. Physicians’ poor awareness of BPPV among physicians and the high efficiency of its treatment in outpatient practice are noted.

  7. Diagnosis and treatment of dizziness in outpatient practice

    Directory of Open Access Journals (Sweden)

    L. M. Antonenko


    Full Text Available Objective: to study the causes of dizziness and instability in patients during an outpatient specialized appointment and to analyze and improve typical management tactics for these patients. Patients and methods. In 2009 to 2014, neurologists, dizziness specialists, examined 300 patients (122 men and 178 women aged 18 to 85 years, who complained of dizziness and instability. Prior to the examination, the patients had been diagnosed as having dyscirculatory encephalopathy (46%, vertebrobasilar insufficiency (30%, cervical osteochondrosis (12%, and vegetative dystonia (7%. Results and discussion. The examination established the causes of dizziness: benign paroxysmal positional vertigo (BPPV (34%, phobic postural instability (22%, multiple sensory insufficiency (15%, Meniere's disease (7%, migraine-associated vertigo (5%, vestibular neuronitis (4%, acute cerebrovascular accident (4%, and other diseases (9%. In accordance with the established diagnosis, adequate treatment which could completely eliminate or substantially reduce the magnitude of dizziness in the majority of cases was performed. The paper describes two clinical cases (BPPV and Meniere's disease. Betahistine dihydrochloride (vesticap, betaserc were most commonly used in a dose of 48 mg/day to treat vestibular vertigo. It gives the results of comparative treatment (with vesticap or betaserc for vestibular vertigo in 62 patients. The authors note the low level of diagnosis and effective treatment in patients with dizziness in outpatient practice. They show the expediency of a specialized examination, the efficiency and safety of current treatments, including medication therapy with betahistine dihydrochloride (betaserc and vesticap and rehabilitation on a stabiligraphic platform with biofeedback, for vestibular vertigo. 

  8. effectiveness of intermittent preventive treatment with sulphadoxine

    African Journals Online (AJOL)


    Aug 8, 2011 ... East Africa Medical Journal Vol. ... AND INSECTICIDE TREATED NETS ON THE PREVENTION OF MALARIA IN PREGNANCY IN NON-MALARIAL .... With a population of 18,000 pregnant women annually. Study Duration. The study was conducted between. February and August 2010. Study Area: The ...

  9. . ORIGINAL ARTICLES Prevention and treatment of cardiovascular ...

    African Journals Online (AJOL)

    Since the clinical neonatal outcome is not worse after the use of ephedrine, it currently remains the first-line agent in most units. Adrenaline is not routinely used as an agent to prevent or treat spinal hypotension. Following a bolus dose its effect is brief and it is associated with cardiac arrhythmias. Because its use may be ...

  10. Prevalence of intermittent preventive treatment with sulphadoxine ...

    African Journals Online (AJOL)

    Cite as: Orish VN, Onyeabor OS, Boampong JN , Afoakwah R, Nwaefuna E, Acquah S, et al. Prevalence of intermittent preventive treat- ment with sulphadoxine-pyrimethamine (IPTp-SP) use ..... by the increase of SP drug resistance in pregnant wom- en in Ghana since the adoption and implementation of. IPTp-SP policy35.

  11. Diagnosis and treatment of the pelvic congestion syndrome. (United States)

    O'Brien, Marlene T; Gillespie, David L


    Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their lifetime. Pelvic congestion syndrome (PCS) is defined as chronic pelvic pain resulting from reflux or obstruction of the gonadal, gluteal, or periuterine veins, sometimes associated with perineal or vulvar varices. It can also be caused by compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, also known as the nutcracker syndrome. Whereas PCS accounts for up to 30% of patients presenting with chronic pelvic pain, it is frequently underdiagnosed. We reviewed the literature to investigate the current state of the diagnosis and treatment of this disorder. An online database search was performed with MEDLINE. MeSH headings included PCS, chronic pelvic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies. Our MEDLINE search revealed more than 3756 references to chronic pelvic pain. Specific references to PCS, pelvic chronic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies, however, included only 260 references. Thirty-seven references were small series including fewer than 50 patients or individual case reports documenting medical, surgical, or endovascular treatment of PCS. The majority of these papers demonstrated successful treatment of symptoms from PCS with embolization of one or both ovarian veins in addition to treatment of refluxing internal iliac vein branches. In addition, open surgery and, more recently, endovascular stenting of LRV obstruction have shown some promise in alleviating symptoms attributed to nutcracker syndrome. Diagnosis of PCS requires a careful history, physical examination, and noninvasive imaging. Several large case series have

  12. Applications of nanotechnology for melanoma treatment, diagnosis, and theranostics

    Directory of Open Access Journals (Sweden)

    Chen J


    Full Text Available Jiezhong Chen,1,2 Renfu Shao,3 Xu Dong Zhang,4 Chen Chen1 1School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia; 2Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia; 3GeneCology Research Centre, School of Science, Education and Engineering, University of the Sunshine Coast, Maroochydore, QLD, Australia; 4School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Abstract: Melanoma is the most aggressive type of skin cancer and has very high rates of mortality. An early stage melanoma can be surgically removed, with a survival rate of 99%. However, metastasized melanoma is difficult to cure. The 5-year survival rates for patients with metastasized melanoma are still below 20%. Metastasized melanoma is currently treated by chemotherapy, targeted therapy, immunotherapy and radiotherapy. The outcome of most of the current therapies is far from optimistic. Although melanoma patients with a mutation in the oncogene v-Raf murine sarcoma viral oncogene homolog B1 (BRAF have an initially higher positive response rate to targeted therapy, the majority develop acquired drug resistance after 6 months of the therapy. To increase treatment efficacy, early diagnosis, more potent pharmacological agents, and more effective delivery systems are urgently needed. Nanotechnology has been extensively studied for melanoma treatment and diagnosis, to decrease drug resistance, increase therapeutic efficacy, and reduce side effects. In this review, we summarize the recent progress on the development of various nanoparticles for melanoma treatment and diagnosis. Several common nanoparticles, including liposome, polymersomes, dendrimers, carbon-based nanoparticles, and human albumin, have been used to deliver chemotherapeutic agents, and small interfering ribonucleic acids (siRNAs against signaling molecules have also been tested for the treatment of melanoma. Indeed

  13. Compulsory outpatient treatment can prevent involuntary commitment

    DEFF Research Database (Denmark)

    Hansen, Lene Nørregård; Svensson, Eva Maria Birgitta; Brandt-Christensen, Anne Mette


    Compulsory outpatient treatment (co-pt) has been possible in Denmark since 2010. The aim is to secure necessary treatment, reduce involuntary commitment and improve quality of life for patients with a severe psychiatric illness. Co-pt has been brought into use in 33 cases. This case report...

  14. ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm

    Directory of Open Access Journals (Sweden)

    R. Mason Curtis


    Full Text Available Introduction: Upper airway angioedema is a life-threatening emergency department (ED presentation with increasing incidence. Angiotensin-converting enzyme inhibitor induced angioedema (AAE is a non-mast cell mediated etiology of angioedema. Accurate diagnosis by clinical examination can optimize patient management and reduce morbidity from inappropriate treatment with epinephrine. The aim of this study is to describe the incidence of angioedema subtypes and the management of AAE. We evaluate the appropriateness of treatments and highlight preventable iatrogenic morbidity. Methods: We conducted a retrospective chart review of consecutive angioedema patients presenting to two tertiary care EDs between July 2007 and March 2012. Results: Of 1,702 medical records screened, 527 were included. The cause of angioedema was identified in 48.8% (n=257 of cases. The most common identifiable etiology was AAE (33.1%, n=85, with a 60.0% male predominance. The most common AAE management strategies included diphenhydramine (63.5%, n=54, corticosteroids (50.6%, n=43 and ranitidine (31.8%, n=27. Epinephrine was administered in 21.2% (n=18 of AAE patients, five of whom received repeated doses. Four AAE patients required admission (4.7% and one required endotracheal intubation. Epinephrine induced morbidity in two patients, causing myocardial ischemia or dysrhythmia shortly after administration. Conclusion: AAE is the most common identifiable etiology of angioedema and can be accurately diagnosed by physical examination. It is easily confused with anaphylaxis and mismanaged with antihistamines, corticosteroids and epinephrine. There is little physiologic rationale for epinephrine use in AAE and much risk. Improved clinical differentiation of mast cell and non-mast cell mediated angioedema can optimize patient management.

  15. [Prevention and treatment of tardive dyskinesia caused by antipsychotic drugs]. (United States)

    Seigneurie, A-S; Sauvanaud, F; Limosin, F


    Tardive dyskinesia (TD) is a movement disorder of tongue, jawbone, trunk and/or limbs that may appear after a prolonged use of dopamine receptor blocking agents (after 3 months of treatment or after 1 month for patients over 60), and that are present during at least four consecutive weeks. TD is a frequent side effect of both classical neuroleptics and new generation antipsychotic drugs. The prevalence of iatrogenic TD is between 24 and 32 % after treatment with classical neuroleptics and about 13 % after treatment with a new generation antipsychotic. This paper presents an updated literature review of data on diagnosis, prevention and treatment of TD. We conducted a review of literature using the Medline Browser tool, screening studies from 1950 to 2013 in English or French with keywords « tardive dyskinesia », « tardive dystonia », and « abnormal movements caused by antipsychotic drugs ». We first describe and define semeiological features of TD: dystonia, tremor, myoclonus, acathisie, chorea, ballism and athetosia. Secondarily, we resume the main differential diagnoses to exclude when confronted with this kind of movement disorders. Differential diagnoses for dyskinesia can be classified between primary (Parkinson and Huntington diseases) and secondary (Wilson disease, intoxication, metabolic abnormality, cerebrovascular accident) abnormal movements. Psychogenic TD can be evocated if previous pathologies are excluded in case of atypical clinical presentation. We detail the risk factors for TD. Endogenous risk factors are related to the patient's age, underlying psychiatric disease (bipolar disorder or Alzheimer dementia), addiction to alcohol or cocaine, female gender, or neurodevelopmental vulnerability. Iatrogenic risk factors are high doses of antipsychotics, long or intermittent administration, and particular pharmaceutical classes or associations of antipsychotics. As a comprehensive tool, we review the main physiopathological hypotheses to

  16. The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care (United States)


    Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring. PMID:25317368

  17. Screening, prevention, and treatment of congenital cytomegalovirus. (United States)

    Johnson, Julie; Anderson, Brenna


    Congenital cytomegalovirus (CMV) is a leading cause of permanent disability in children. The main source of maternal infection is from contact with young children. Primary maternal infection is diagnosed with demonstration of seroconversion or a positive CMV IgM in combination with a low-avidity CMV IgG. Fetal infection may be diagnosed with amniotic fluid polymerase chain reaction and culture. CMV-specific hyperimmune globulin has shown promise as a possible means to prevent congenital infection; large randomized trials are ongoing. To date, the only effective means of prevention is through reducing exposure to the virus. Rates of maternal infection may be reduced through education regarding sources of infection and improved hygiene. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Childhood obesity treatment and prevention. Psychological perspectives of clinical approaches

    Directory of Open Access Journals (Sweden)

    Maria Catena Quattropani


    Full Text Available Objective: This work focuses on clinical psychologist’ presence within childhood obesity prevention programmes in several countries. Method: The Authors collected articles considering psychological, biological and social aspects linked to childhood obesity. Results: Studies reveal that childhood obesity prevention programmes are based on biological, medical and educational aspects; clinical psychologists up until now have been engaged almost exclusively in the treatment of obesity. Conclusions: There is a clear need to consider psychological aspects (emotional, cognitive and relational related to the childhood obesity’s causes and involve psychologists in its prevention projects. Keywords: childhood obesity, overweight, multidisciplinary approach, clinical psychology, prevention, treatment

  19. New insights in diagnosis and treatment for Retinopathy of Prematurity. (United States)

    Cernichiaro-Espinosa, Linda A; Olguin-Manriquez, Francisco J; Henaine-Berra, Andree; Garcia-Aguirre, Gerardo; Quiroz-Mercado, Hugo; Martinez-Castellanos, Maria A


    The purpose of this study was to review current perspectives on diagnosis and treatment of Retinopathy of Prematurity (ROP). We performed a systematic review of how much has been produced in research published online and on print regarding ROP in different settings around the world. Early Treatment for ROP (ETROP) classification is the currently accepted classification of ROP. Fluorescein angiography and spectral domain optical coherence tomography (SD-OCT) may eventually lead to changes in the definition of ROP, and as a consequence, they will serve as a guide for treatment. Intravitreal anti-VEGF therapy has proven to be more effective in terms of lowering recurrence, allowing growth of the peripheral retina, and diminishing the incidence of retinal detachment when proliferative ROP is diagnosed. Whether anti-VEGF plus laser are better than any of these therapies separately remains a subject of discussion. Telemedicine is evolving everyday to allow access to remote areas that do not count with a retina specialist for treatment. A management algorithm is proposed according to our reference center experience. ROP is an evolving subject, with a vulnerable population of study that, once treated with good results, leads to a reduction in visual disability and in consequence, in a lifetime improvement.

  20. Multifocal motor neuropathy: a review of pathogenesis, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    Lawson VH


    Full Text Available Victoria H Lawson,1 W David Arnold1,2 1Division of Neuromuscular Disorders, Department of Neurology, 2Department of Physical Medicine and Rehabilitation, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA Abstract: Multifocal motor neuropathy (MMN is an uncommon, purely motor neuropathy associated with asymmetric deficits with predilection for upper limb involvement. Even in the early descriptions of MMN, the associations of anti-GM1 antibodies and robust response to immunomodulatory treatment were recognized. These features highlight the likelihood of an underlying autoimmune etiology of MMN. The clinical presentation of MMN can closely mimic several neurological conditions including those with more malignant prognoses such as motor neuron disease. Therefore early and rapid recognition of MMN is critical. Serological evidence of anti GM-1 antibodies and electrodiagnostic findings of conduction block are helpful diagnostic clues for MMN. Importantly, these diagnostic features are not universally present, and patients lacking these characteristic findings can demonstrate similar robust response to immunodulatory treatment. In the current review, recent research in the areas of diagnosis, pathogenesis, and treatment of MMN and needs for the future are discussed. The characteristic findings of MMN and treatment implications are reviewed and contrasted with other mimicking disorders. Keywords: autoimmune, conduction block, electrodiagnosis, motor neuron, nerve, inflammatory