SN Comprehensive Clinical Medicine最新文献

Inadequate knowledge prevents healthcare professionals from providing the best end-of-life care to dying patients and meeting their needs. To address the unmet need for palliative care, it is also necessary to implement a multi-disciplinary treatment approach to overcome significant barriers, such as the lack of specific palliative care training among healthcare professionals. The study aimed to develop and establish psychometric properties of knowledge and belief questionnaires and investigate the effect of palliative care educational programs on outcomes of knowledge, belief, and attitudes in physiotherapy students at various Indian universities. Knowledge and belief questionnaires were developed, and their reliability and validity were established on 26 final-year physiotherapy students who were subjected to an educational program of six hours on palliative care, and their knowledge, belief, and attitude toward critical care of patients were assessed before and after completion of the program. The results demonstrated that both questionnaires had good content and face validity. The knowledge and belief questionnaires showed good (ICC 0.88, 95% CI (0.73–0.94)) (Cronbach alpha 0.89) and moderate (ICC 0.70, 95% CI (− 0.09– − 0.80)) (Cronbach alpha 0.75) reliability, respectively. Also, a significant improvement was observed in the knowledge, attitudes, and beliefs of students after completion of the educational program (p < 0.05). The self-made knowledge and belief questionnaires were found to be valid and reliable tools for assessing knowledge and belief. A focused educational program on palliative care may be included in the curriculum of physiotherapy students to enhance their knowledge, beliefs, and attitudes.

Plasma lactate level of ≥ 2 mmol/L can predict pulmonary embolism (PE)-associated adverse outcomes but has led to the question of if monitoring lactate concentration can be more reliable than the adequacy of a single measurement. It could be more beneficial to use repeated assessments of lactate concentration to forecast results in this patient group. This study aims to investigate the predictive value of lactate clearance (LC) in short-term mortality in patients diagnosed with PE in the emergency department (ED). A prospective cross-sectional study was conducted in ED of a tertiary care hospital. Patients who were diagnosed with PE over age 18 were enrolled in the study. The risk factors, vital signs, and lactate levels (at arrival and the 2nd hour) at admission were recorded. The Pulmonary Embolism Severity Index (PESI) scores of the patients were calculated. The 24-h, 7-d, and 30-d survival rates of the patients were evaluated. Then, 77 patients were included in the study. PESI score, basal, and 2nd-hour lactate levels were found significant in predicting 30-day mortality (p = 0.002, 0.009, and 0.002, respectively). Receiver operating characteristic (ROC) curve analyses for PESI, basal, and 2nd-hour lactate levels showed an area under curve (AUC) of 0.703 (95% CI: 0.586–0.820), 0.688 (95% CI: 0.552–0.824), and 0.722 (95% CI: 0.586–0.857), respectively. The predictive performances of PESI, basal, and 2nd-hour lactate level were similar. LC was not significant in predicting the 30-day mortality (p = 0.290). LC was not correlated with mortality in patients with PE.

Major depressive disorders (MDD) are among the most common psychiatric disorders affecting people worldwide. The steady increase in cases of depressive disorders has been mainly attributed to enhanced life stress. The association of this clinical condition with other systemic disorders, especially cardiac conditions, raises concerns about increased morbidity and mortality related to this disorder. Investigating neuro-cardiac regulation using heart rate variability (HRV) and cortical excitability using transcranial magnetic stimulation (TMS) in patients with depression can provide crucial insights to understand systemic involvement and possible therapeutic interventions. We recruited 60 patients suffering from moderate depression based on International Classification of Diseases ICD-10 criteria on treatment with Escitalopram for more than 2 months. The HRV measures and TMS techniques using cortical excitability measures with single and paired-pulse TMS measures were performed on all the patients and compared with age- and gender-matched healthy controls. Patients with depression showed significantly lesser standard deviation of normal-to-normal interval (SDNN), root mean square of successive differences (RMSSD), total power (TP), high frequency (HF) power, and increased low frequency (LF) power and LF/HF ratio which together indicate reduced HRV. Reduced short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP) (assessed by TMS) were also observed in patients with depression compared to healthy controls. Patients with depression showed decreased HRV, glutamatergic activity, gamma amino butyric acid-B (GABA-B) activity, and increased GABA-A activity. These findings suggest aberrant neuro-cardiac regulation and cortical excitability in this enigmatic disorder.

Whereas pregnancy and the postpartum states may be generally associated with increased risk for adverse mental health, the COVID-19 pandemic was responsible for supernumerary concerns regarding stressors, anxiety, and depression. A cumulative international experience is becoming apparent. Given the variability of both qualitative and quantitative analyses for maternal psychosocial health during the pandemic, a narrative review was conducted to gauge the international experience and to draw inferences in regard to future initiatives and their implementation. Risk factors for increased maternal psychosocial dysfunction during the pandemic have been variably defined for diverse populations worldwide. Common among the latter were inability to access timely and trustworthy information and professional care, socioeconomic compromise, and lesser prepandemic educational status. The quality and quantity of personal contacts were mitigating factors. Confidence in preventative measures was key to reducing mental health adversity. Time-honored infection control strategies and SARS-CoV-2-specific vaccination contributed both to reduced infections in pregnancy and the postpartum and to a lessening of impact on psychosocial health. Pragmatic implementation and future planning of pandemic responses are key aspects of prevention for adverse psychosocial outcomes in overall maternal care.

Pulmonary interstitial emphysema is a clinical state occurring in newborns and infants that involves lung damage with air leak into the pulmonary interstitium. The data about this condition among newborns with critical heart defects are limited. We report a case of an infant with complex heart disease, 22q11.2 microdeletion, and TNNC1 gene mutation presenting with pulmonary interstitial emphysema. The infant was intubated for respiratory failure and underwent pulmonary artery banding. Weaning from mechanical ventilation was complicated with pulmonary interstitial emphysema and pneumothorax development. Pulmonary interstitial emphysema was fully resolved after lateral decubitus positioning on the affected side down. Complete repair of the common arterial trunk was accomplished at the age of 2 months with no signs of residual pulmonary interstitial emphysema. Lateral decubitus positioning may be effective as a non-invasive treatment in an infant with pulmonary interstitial emphysema and complex heart disease.

Jugular vein phlebectasia (JVP) refers to fusiform, non-tortuous distention of a portion of vein, two to three times its usual size, first addressed by Harris in 1928. It is classically considered a rare benign structural anomaly, with only 247 cases reported. Internal jugular vein is affected in most cases of phlebectasia in head and neck region; it is frequently observed on right side probably due to favorable anatomical features such as larger right internal jugular bulbs, shorter course of right brachiocephalic vein, direct emptying into the superior vena cava, and the close proximity of right innominate vein to the apical pleura, therefore risking the right IJV as the intrathoracic pressure rises. It presents as a soft, compressible, and painless swelling over the lateral neck, briefly emerging with augmented intrathoracic pressure, like during coughing, straining or performing Valsalva. Treatment strategy is usually conservative. A 7-year-old male child presented with complaint of intermittent left sided neck swelling, noticed by parents when the child cries or shouts and disappears afterward. X-ray neck was done which came normal with no unusual air shadow. CT scan reported fusiform ectasia of left internal jugular vein in neck at the level of thyroid gland, about 1.6 × 2.7 × 4.8 cm in size with the diagnosis of “phlebectasia.” This case report unveils an extremely rare occurrence of phlebectasia that typically affects children and on the right side of the neck, by presenting on the left side, highlighting the unpredictable nature of this already uncommon condition in Asia.

Abstract

Numerous drugs prolong the QT interval, and drug-induced QT prolongation is a frequently encountered situation in hospital settings. QT prolongation increases the risk of Torsades de Pointes (TdP), which can be life-threatening. A 70-year-old female with a history of atrial flutter post ablation and ischemic heart disease was admitted for shortness of breath and found to be in atrial flutter with variable atrioventricular block. She was treated with intravenous amiodarone, digoxin loading dose, beta-blockers, and diuretics. The patient converted to sinus rhythm but developed QT prolongation and TdP secondary to amiodarone. The drug was discontinued. After ruling out active ischemia, a diagnosis of idiosyncratic amiodarone-induced TdP was made. Although the incidence of TdP due to amiodarone use is rare, idiosyncratic amiodarone-induced TdP can occur secondary to long QT syndrome or polymorphisms. The treatment includes holding the drug, administration of magnesium sulfate, replenishment of all electrolytes, and cardioversion if needed. Although amiodarone is considered a low-risk drug for precipitating TdP, risk factors including older age, female sex, ischemic heart disease, and electrolyte abnormalities are essential considerations. Drug-induced TdP can be life-threatening due to its potential to degenerate into ventricular fibrillation. Prompt recognition, discontinuation of the drug, and empiric administration of magnesium sulfate are essential.

Abstract

Anemia is common in chronic kidney disease (CKD). Erythropoietin is the standard treatment for anemia of CKD. We evaluated the frequency and etiologies of erythropoietin-resistant anemia in children under dialysis. A prospective study was conducted at a tertiary academic center from October to March 2020. Erythropoietin-resistant anemia was defined as not achieving target hemoglobin ≥ 11 gr/dl four and 6 months after receiving erythropoietin 300IU/kg/week. Sixty-one patients were enrolled; 49.2% were girls with a median age of 9 years and 4 months. The median time from placement on dialysis was 20.9 months. They consisted of hemodialysis (47.5%) and peritoneal dialysis (52.5%) patients. Erythropoietin (EPO)-resistant anemia was reported in the fourth and sixth months of treatment in 43.1% and 42.85% cases, respectively. The most identified causes in the fourth month of the study were iron deficiency, hyperparathyroidism (each in 36%), drugs (24%), and infections (20%). In the sixth month of the study, iron deficiency (57.15%), hyperparathyroidism (19.04%), and drugs (14.3%) were the most commonly identified etiologies. Age, duration placed on dialysis, gender, and modality of dialysis did not significantly correlate with erythropoietin-resistant anemia (P > 0.05 for all). Mean serum urea and median parathyroid hormone (PTH) levels were significantly higher in cases with EPO-resistant versus EPO-deficient anemia (P = 0.026 and 0.049, respectively). Erythropoietin-resistant anemia was common in children under dialysis. Iron deficiency, hyperparathyroidism, and infections were the main identified etiologies. We found a significant correlation between serum urea and PTH levels with EPO-resistant anemia.

Abstract

Anti-heparin–platelet factor 4 (anti-HPF4) antibodies play a key role in heparin-induced thrombocytopenia (HIT). These antibodies can participate in thrombosis and mortality through platelet activation. HIT is a life-threatening complication. Recently, HIT has been reported as a risk factor of thrombocytopenia exacerbation in COVID-19 patients. In the present study, we assessed the incidence of anti-HPF4 in patients with COVID-19 and the relationship with ICU hospitalization and mortality. This cross-sectional descriptive study was performed on 97 COVID-19 patients in Yasuj City (Southwest zone of Iran). Demographic factors and platelet count, PT, APTT, and D-dimer were recorded and checked at admission and during hospitalization. Anti-HPF4 antibody assay was performed for all eligible patients by ELISA method. Statistical significance was based on two-sided design-based tests evaluated at the 0.05 level of significance. Most of the patients (n = 57, 58.8%) were male. The mean age of the patients was 55.46 ± 15.2 years, and the mean hospitalization was 17.57 ± 7.2 days. The mean length of stay was 209.9 ± 79.8 × 10³/µL. The results of the anti-HPF4 antibody assay showed that 9.3% (n = 9) of the patients were positive for anti-HPF4 antibody. The mortality rate was higher in the HPF4-positive patients. Although the true frequency of HIT in this study was unclear, it can be concluded that anti-HPF4 antibodies are involved in the pathophysiology of HIT which is a life-threatening complication in COVID-19 patients receiving heparin treatment, with a high rate of morbidity and mortality.