Monday, 31 October 2016

When Heart Failure has to do with Past Abdominal Surgery

A 70-year-old woman, with a past medical history of permanent atrial fibrillation, cholecystectomy for symptomatic gallstones and obesity (54 kg/m2 body mass index), was admitted to the hospital for rapidly increasing dyspnea (NYHA class III). At admission, heart rate was 110 beats per minute(bpm) and blood pressure was 125/73 mmHg. Physical examination revealed clinical signs of right heart failure including major peripheral oedema, hepatomegaly, bilateral pleural effusion, and ascites with no signs of portal hypertension or hepatocellular insufficiency.

Past Abdominal Surgery
On the first transthoracic echocardiogram, preserved left ventricular ejection fraction with normal diastolic function was noticed. Interestingly, a major dilatation of the right ventricle, the right atrium, and the inferior vena cava (45 mm) were observed. Systolic pulmonary artery pressures were estimated as high as 60 mmHg with the tricuspid regurgitation, and cardiac index was increased, reaching 4.8 L/min/m2. Pulmonary assessment on the six-minute walk test was satisfying at 255 meters, and a small restrictive impairment was documented on a pulmonary function test (assigned to obesity). Finally, no perfusion defect was found on the ventilation/perfusion lung scan.

Thursday, 27 October 2016

Assessment of Superordinate Categorization in 2-4 years Typically Developing Children

Classification is a powerful cognitive process, allowing us to organize a great deal of information efficiently and flexibly. When we form classes, we highlight important similarities among objects and events, treating very different items as equivalent for certain purposes, since a particular item could be a member of many different classes.

Typically Developing Children
For example, an apple can be classified under ‘fruit’, ‘food’, ‘physical object’, etc. These classes are hierarchically organized and they honor inclusion relations.

Taxonomic categorization involves classification of items into groups based on similarities in the characteristics, structure, origin etc of the stimuli.In taxonomic categorization, it is often expected that items in a group have a strong association between them.

Wednesday, 26 October 2016

Frequency and Etiology of Community-Acquired Bloodstream Infection in Hospitalized Febrile Children

Bloodstream infection is a severe problem that needs immediate attention and treatment as it can lead to morbidity and mortality. Fever is often the most common reason for presentation to the hospital in developing countries.

Bloodstream Infection
Most patients with febrile illness have selflimiting viral infections, but some have a serious bacterial infection that needs urgent and appropriate antimicrobial therapy advance in blood culture technique have resulted in efficient and reliable techniques for detection of bacterial and fungal pathogens.

Blood stream infection is a cause of high mortality especially if caused by multidrug-resistant bacteria. Bacteriologic culture to isolate the offending pathogen and knowledge about sensitivity pattern of isolates remains the mainstay of definitive diagnosis and management of bloodstream infection.

Tuesday, 25 October 2016

Use of Smokeless Tobacco in Medical Students and Hypertension

Tobacco is being used in various forms including cigarette, shisha, cigar and bidi smoking and smokeless tobacco. Smokeless tobacco constitutes various forms of tobacco i-e paan/ betel quid, tobacco with lime, naswar, gutka, qiwam, tobacco tooth powder, minpuri, areca nut (supari).

Smokeless Tobacco
Qiwam consists of thick paste of boiled tobacco mixed with powdered spices such as saffron, cardamom, aniseed and aroma, while paan/ betel quid is a mixture of the leaf of the Piper betle vine, aqueous calcium hydroxide paste [slaked lime].

Smokeless tobacco is commonly used in South Asia, where it has become part of South Asian culture. Furthermore, South Asia is a major producer and exporter of tobacco and over one-third of tobacco consumed in South Asia is smokeless.

Monday, 24 October 2016

Practice Management Role in Monitoring Family Medicine Residents Adherence to ACGME-I Standards in Qatar

One of ACGME-I requirements was the practice management curriculum, Practice management curriculum is an essential tool, which can help in several ways, Besides training schedule, physician alert system, and several other innovative aspects of monitoring resident’s performance and prearranged activities, this will also reflect with equal measure on any training institute as well.

Monitoring Family Medicine Residents
Practice management report is a tool used to evaluate practice activity and productivity for each resident. It also monitors their practice performance progression.

individuals/practice productivity which includes total number of patient visits seen by the resident in continuity care clinics , total number of visits to hospitalized patients, patient visits distribution by gender, patient visit distribution by age , patient visits distribution by presenting illness, and chart (SOAP) documentation.

Friday, 21 October 2016

Top 15 Tips on Becoming an Effective Medical Simulation Performer

Effective Medical Simulation Performer
Medical simulation has become an important platform for medical education by allowing learners to be exposed to rare but challenging clinical and social situations in a targeted, simulated learning environment.

While high-fidelity simulation incorporates advanced programming software with life-like manikins that can blink, sweat, or even bleed, technology’s ability to replicate real-time human interactions remains limited.

The use of human actors/standardized patients can add significant constructive tension and realism to a case, and permits exploration of complex patient-provider dynamics.

Thursday, 20 October 2016

Tessier 30 Facial Cleft- Median Cleft of Upper and Lower Lip, Lower Alveolus and Mandible, Ankyloglossia and Cervical Teratoma

Cleft lip and palate are common, whereas median mandibular clefts are extremely rare anomaly found in cleft no. 30 in Tessier’s classification. This anomaly was first time reported by Couronne in 1819. So far upto 70 cases have been described in history.

Lower Alveolus and Mandible
Associated anomalies are lower lip hemangioma, facial anomalies, ankyloglossia, cleft palate, cervical dermoid cyst, hyoid bone agenesis, laryngeal cartilage malformation, epiglottis aplasia, cardiac malformation and chromosomal abnormalities, which further worsen the prognosis.

Failure of union of the first branchial arch in midline results in lower midline facial cleft defect whereas failure of fusion of the lower branchial arch elements are thought to lead to associated deformities of the neck.

Wednesday, 19 October 2016

Perhaps its Time to Move on to Individually Tailored and Focused Treatment in the Aged Population

Geriatric population is increasing by the day, and what’s more worrisome are the accompanying morbidities with aging. Multimorbidity seems to be a common presentation in the aged which usually leads to polypharmacy, and that again is a growing concern. As we had said many years ago, it’s not that the aged are looking forward to increased longitivity.

Treatment in the Aged Population
They are probably more interested to remain fit enough so as to carry on with their daily chores, as was opined by us. Since one size will never fit all, therefore, based on the multi-morbidities an individually tailored approach may perhaps be more helpful. With the decline of the bodily functions and physiology as we age, there can be so many different medical and physical disabilities.

There can be all sorts of combinations of problems, some apparent and many unapparent, which will require all the skills and expertise from a Geriatrician or from the treating physician. May be a revisit and a fresh look at all the problems from head to toe might help in pruning down the list of diagnosis, which in turn could also help to curtail inadvertent polypharmacy.

Monday, 17 October 2016

Geriatric Depression and Cognitive Impairment

More than 350 million people are affected by depression making it one of the most common disorders in the world. It is the biggest cause of disability, and as many as two-thirds of those who commit suicide have the condition.

Cognitive Impairment
But although depression is common, it is often ignored.Depression in older adults is a very common condition that creates a major problem for public health. A high percentage of this population is under-diagnosed in primary care.

It has been demonstrated that depression is associated with cognitive impairment due to vascular factors, degenerative process, or emotional compromise. Moreover, it could be also related with social and psychological distress situations, or co-morbid clinical diseases (chronic diseases, cancer, neurological diseases, etc.)

Promoting Palliative Care to Cancer Patients in the Republic of Kazakhstan

In his recent book, Palliative Care: The 400-Year Quest for a Good Death , [1] Harold Vanderpool traces the emergence of medical palliation to a proclamation by Sir Francis Bacon in 1605 challenging physicians to offer and continually improve palliative medical care and treatment for dying persons.

Palliative Care to Cancer Patients
Florence Nightingale also contributed significantly to the evolution of what we call palliative care today, although the period of 1895 to 1959 – a time of great advances in medicine – unfortunately led to less appropriate care for the dying, though it contributed to discussions about the ethics of treating the dying. The following period (1960-1981) is described as a time of momentous transition.

The influence of Elisabeth Kübler-Ross and Cicely Saunders emerged, solidifying palliative care concepts in the US and UK, and thereafter worldwide.In 2015 the WHO added palliative care to its family of factsheets for the first time.

Friday, 14 October 2016

Comparison of Hormones, Lipoproteins and Substrates in Blood Plasma in a C57bl6 Mouse Strain after Starvation and a High Fat Diet

Metabolic syndrome, the complex of conditions that put humans to risk for coronary heart disease and type-2 diabetes, is increasingly common in Western countries. In North America, it is estimated that over 50 million American people or 20% of the US population are affected.

Lipoproteins and Substrates
In addition, the numbers of cases are also increasing in Europe.Obesity is a strong factor involved in metabolic syndrome, and some researchers claim metabolic syndrome is in itself closely linked to the metabolic derangement called insulin resistance in humans.

Early signals of emerging obesity might be found in the blood, which functions as the body’s transport medium by carrying nutrients, lipids and waste products between cells.

Thursday, 13 October 2016

Preparing for the Rise in Alzheimers Disease Cases: A Proposal for Training Support Personnel

As the baby-boomer generation continues to age, the number of Alzheimer’s disease cases is expected to double in the next decade. The functional disability and need for clinical management associated with this trend will outstrip our current workforce.

Alzheimers Disease
Making the correct diagnosis and prescribing cognitive enhancing drugs is relatively easy compared to the time and effort required to educate and support caregivers and help them cope with the complications of neurocognitive disorders such as depression, psychosis, agitation, and growing dependency for basic function.

Ninety five percent of these patients will be managed in home settings that will require time and effort from family members who are traditionally women that manage their own family with children as well as their aging parents, many of whom also work themselves to make ends meet financially. Social service agencies will therefore figure large in this equation to provide day care and in-home help.

Wednesday, 12 October 2016

A Validated Method for Titanium Implant Anchorage Analysis using Micro CT and Biomechanical Testing

The use of uncemented titanium endosseous implants for restorative dentistry and orthopaedic surgery has been the standard of care for several decades. Endosseous implantation using uncemented titanium prostheses is commonly performed in trabecular bone sites such as the jaws, vertebrae and ileum.

Biomechanical Testing
Still, the mechanisms involved in this fascinating and unique interaction between a living tissue and foreign substance are poorly understood. An important reason for the absence of sufficient mechanistic information is the lack of robust experimental models combined with solid tools to analyze structurefunction relationships of the implant-bone system.

Qualitative and quantitative ex vivo analysis of peri-implant tissues is typically done by means of light microscopy using thin histological sections following implant removal or thicker ground sections which contain the implant and undecalcified bone. These techniques are labor-intensive and thus time-consuming.

Monday, 10 October 2016

Challenges to Palliative Care in Pediatric Patients

The incidence of cancer is rising in pediatric population since last decade. In 2016, about 10,000 children are projected to be diagnosed of cancer in United States.

Palliative Care in Pediatric Patients
Though five-year survival in most of the pediatric cancer patients is more than 80% now, cancer remains the most common cause of mortality after trauma in age group 5-14 years. The growing population of pediatric cancer survivors warrants parallel rise in the palliative care.

As per the World Health Organization (WHO) palliative care is, ‘An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.

Tuesday, 4 October 2016

Serum Biomarkers for Sepsis

Sepsis is defined as the presence of a serious infection that correlates with systemic and uncontrolled immune activation. It is associated with high mortality, largely due to multi-organ failure. Sepsis could be extremely dangerous in infants, elderly population, immunocompromised and critically ill patients.

Sepsis
Early diagnosis and prompt appropriate intervention is essential to halt the progression of sepsis and improve survival. A positive blood culture is the commonly used assay in sepsis diagnosis. However, this diagnostic tool has its limitations as culture is time dependent resulting in delay. Furthermore, positive blood cultures may not be present in many patients with sepsis.

In recent years, serum lactate testing in sepsis has become popular and it is being used in many centers to expedite early treatment and to monitor response of the therapy. Researchers have been working for quite some time to identify a "perfect biomarker" for early diagnosis of sepsis.

Influence of the Implant Prosthetic Restorations Components on the Stress Values and Distribution in Surrounding Bone - Finite Element Analysis Study

Currently the implant-prosthetic therapy is widespread and has a great success regarding the rehabilitation of edentulous patients. Although in many studies it has been reported a high rate success for this type of treatment, in daily practice is very difficult to avoid failures that consist in different complications such as mechanical or aesthetic ones, resulting in relatively short term or late loss of the dental implants.

Bone - Finite Element Analysis
This is the reason why the researchers’ concern has been focused on finding the appropriate ways to increase the success rate of the implant prosthetic therapy. Randomized clinical trials and in vitro studies such as the finite element analysis are necessary to assess the efficiency of the biomaterials and of the biomechanical aspects of all the components, including the surrounding bone.
The success or failure of the implant-prosthetic treatment is influenced by the stresses developed in the periimplant bone and the stress values and distribution that depend both on the implant and the bone characteristics.

Monday, 3 October 2016

Challenges to Palliative Care in Pediatric Patients

The incidence of cancer is rising in pediatric population since last decade. In 2016, about 10,000 children are projected to be diagnosed of cancer in United States. Though five-year survival in most of the pediatric cancer patients is more than 80% now, cancer remains the most common cause of mortality after trauma in age group 5-14 years.

Palliative Care in Pediatric Patients
The growing population of pediatric cancer survivors warrants parallel rise in the palliative care. As per the World Health Organization (WHO) palliative care is, ‘An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness.

Through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’. Notably contemp orary thoughts advocate the integration of curative and palliative approaches in pediatric patients.